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Intraoperative MR Imaging Guidance for Intracranial Neurosurgery: Experience with the First 200 Cases¹

¹ From the Depts of Radiology (R.B.S., L.H., T.Z.W., D.F.K., A.A.Z., R.K., F.A.J.) and Surgery, Div of Neurosurgery (P.M.B., E.A., P.E.S., T.M.M., C.A.M.), Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115. From the 1997 RSNA scientific assembly. Received Mar 18, 1998; revision requested May 14; revision received Aug 12; accepted Oct 26. Supported in part by NIH grants PO1 CA 67165, P41 RR13218, R01 RR11747, and R01 CA 45743 and by the National Science Foundation. Address reprint requests to R.B.S.

PURPOSE: To review preliminary experience with an open-bore magnetic resonance (MR) imaging system for guidance in intracranial surgical procedures.

MATERIALS AND METHODS: A vertically oriented, open-configuration 0.5-T MR imager was housed in a sterile procedure room. Receive and transmit surface coils were wrapped around the patient's head, and images were displayed on monitors mounted in the gap of the magnet and visible to surgeons. During 2 years, 200 intracranial procedures were performed.

RESULTS: There were 111 craniotomies, 68 biopsies, 12 intracranial cyst evaluations, four subdural drainages, and five transsphenoidal pituitary resections performed with the intraoperative MR unit. In each case, the intraoperative MR system yielded satisfactory results by allowing the radiologist to guide surgeons toward lesions and to assist in treatment. In two patients, hyperacute hemorrhage was noted and removed. The duration of the procedure and the complication rate were similar to those of conventional surgery.

CONCLUSION: Intraoperative MR imaging was successfully implemented for a variety of intracranial procedures and provided continuous visual feedback, which can be helpful in all stages of neurosurgical intervention without affecting the duration of the procedure or the incidence of complications. This system has potential advantages over conventional frame-based and frameless stereotactic procedures with respect to the safety and effectiveness of neurosurgical interventions.

Index terms: Brain, MR, 10.121411, 10.121412, 10.12143 • Brain, surgery, 10.439 • Brain neoplasms, 10.146, 10.363, 10.37, 10.38 • Brain neoplasms, therapy, 10.1261, 10.1263, 10.1267 • Magnetic resonance (MR), guidance, 10.121411, 10.121412, 10. 12143 • Magnetic resonance, technology

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