Intraoperative magnetic resonance imaging guidance for intracranial neurosurgical procedures

A 0.5 Tesla open configuration magnetic resonance imaging (MRI) system (Signa SP [GE Medical Systems; Milwaukee, WI]) is sited in an operating room environment at Brigham and Women's Hospital for MRI-guided surgical and interventional procedures. The vertical gap provides patient access to two surgeons or interventionalists, whereas open flexible transmit-receive coils allow exposure of the surgical field. A major application of this system at Brigham and Women's Hospital is intraoperative MRI guidance for intracranial biopsies and open craniotomies. During the past 2 1/2 years, more than 200 intracranial procedures have been performed using intraoperative MRI guidance. For intracranial biopsies, MRI guidance provides several advantages, including high sensitivity for lesion localization; interactive navigation, eliminating the need for a stereotactic frame; multiplanar image confirmation of biopsy site location; and early detection of complications. Based on our experience with open craniotomies, we think that image guidance significantly improves the ability of the neurosurgeon to resect abnormal tissue selectively while preserving adjacent eloquent areas. Furthermore, our experience indicates that intraoperative imaging offers advantages over conventional stereotactic image guidance, including the ability to compensate for shifts in brain position during surgery, and allows for early identification of complications. Intraoperative MRI-guided neurosurgery is a multidisciplinary effort involving the neurosurgeon, neuroradiologist, technologist, nursing staff, and engineers. In our experience, there is little doubt that MRI guidance improves the technical aspects of the neurosurgical procedures; however, the impact of this technology on clinical outcomes and cost effectiveness await further study.

Duke Scholars

Author Terence Z. Wong Radiology, Nuclear Medicine