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See other articles in PMC that cite the published article. Abstract Intraoperative MRI ioMRI dates back to the s and since then has been successfully applied in neurosurgery for three primary reasons with the last one becoming the most significant today: Introduction Since the early s when we introduced intraoperative MRI ioMRI to the field of neurosurgery, it has greatly developed and the number of users and clinical applications have increased [ 1 — 10 ].

The original reasons to develop ioMRI were the following: The navigational systems used in operating rooms rely on preoperative images that do not reflect changes in brain anatomy due to deformations and shifts during surgery. This situation has caused inaccurate targeting and major limitations for neuronavigation.

Neurosurgery | Intraoperative MRI-Guided Neurosurgery

Today, by updating information on the brain using a 3D image database, navigation is made more accurate throughout the entire surgical procedure [ 11 , 12 ]. The original idea of MRI-guided interstitial laser brain surgery leveraged the temperature sensitivity of MRI to allow for temperature monitoring during the procedure [ 13 — 20 ].


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Today, radio-frequency RF and focused ultrasound thermal ablations can similarly be controlled through MRI [ 21 — 26 ]. MRI allows the clinician to verify completeness of tumor removal at the end of surgery and, if needed, to perform an additional tumor resection.

The original vision for ioMRI focused on correcting for brain shift and monitoring temperature, while today most users apply to perform ioMRI for the third reason: As far as clinical applications are concerned, ioMRI has been successfully developed and implemented for multiple procedures, including: Biopsies and placement of electrodes.

Managing the Brain Shift Challenge Navigational systems fully integrated with ioMRI are also part of improved image guidance [ 8 , 11 , 36 — 39 ]. Methods of monitoring brain shift now include: Open in a separate window. Footnotes Conflict of interest statement Dr. Craniotomy for tumor treatment in an intraoperative magnetic resonance imaging unit. High-field strength interventional magnetic resonance imaging for pediatric neurosurgery.

Intraoperative magnetic resonance imaging and magnetic resonance imaging-guided therapy for brain tumors.

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Neuroimaging Clin N Am. Superconducting open-configuration MR imaging system for image-guided therapy. Intraoperative MR imaging guidance for intracranial neurosurgery: Cranial surgery navigation aided by a compact intraoperative magnetic resonance imager. Intraoperative magnetic resonance imaging with the magnetom open scanner: A mobile high-field magnetic resonance system for neurosurgery.


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Neuronavigation in interventional MR imaging. Serial intraoperative magnetic resonance imaging of brain shift. Preliminary experience with MR-guided thermal ablation of brain tumors.


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  • Intraoperative MRI in neurosurgery: technical overkill or the future of brain surgery??
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Interstitial thermotherapy of central brain tumors with the Nd: J Clin Laser Med Surg. Stereotactic laser therapy in cerebral gliomas.

Intraoperative MRI with Brain Path

Acta Neurochir Suppl Wien ; MRI-guided laser-induced interstitial thermotherapy of cerebral neoplasms. J Comput Assist Tomogr. Monitoring and visualization techniques for MR-guided laser ablations in an open MR system. J Magn Reson Imaging. Magnetic resonance image-guided thermal ablations. Top Magn Reson Imaging.

Intraoperative MRI-Guided Neurosurgery

Temperature monitoring of interstitial thermal tissue coagulation using MR phase images. Focused US system for MR imaging-guided tumor ablation. Thermal effects of focused ultrasound on the brain: Jolesz FA, Hynynen K. Magnetic resonance image-guided focused ultrasound surgery. MR imaging-controlled focused ultrasound ablation: Current status and future potential of MRI-guided focused ultrasound surgery. MRI evaluation of thermal ablation of tumors with focused ultrasound. Survival rates in patients with low-grade glioma after intraoperative magnetic resonance image guidance.

Mittal S, Black PM. It also enables surgeons to achieve a high rate of accuracy—approximately 0. Patient benefits also cannot be overlooked. MRI-guidance is enabling a variety of minimally invasive procedures for a broad range of patients. Likewise, MRI-guided laser ablation may be used for patients with epilepsy, brain tumors, and radiation necrosis.

MRI-guidance technology has even been utilized to facilitate hybrid cases in which a combination of diagnostic and therapeutic procedures are performed in a single setting, such as a biopsy followed by cyst drainage followed by laser ablation of a brain tumor. The overwhelming majority of hospitals performing MRI-guided, minimally invasive neurosurgery are doing so in one of their standard diagnostic MRI suites, and for good reason.

Outfitting an existing standard diagnostic suite for minimally invasive procedures typically requires a relatively small investment and obviates the need for a multimillion-dollar intraoperative MRI capital purchase when initially evaluating the new approach. Current MRIguided technologies have been designed to enable procedures in existing diagnostic suites based on the fact that they far outnumber their MR-OR counterparts—more than 5, diagnostic MRI scanners to only around 75 intraoperative MRI suites across the United States.

At certain institutions, performing initial MRI-guided neuro procedures in an existing diagnostic suite can serve as a stepping stone that ultimately does lead to a later investment in a MR-OR suite. Of course, there are some concerns to performing neurosurgical interventions in the diagnostic MRI setting. Topics of specific interest include economics, sterility, procedure workflow, and hospital politics.

The sequences used can also be tailored to limit the amount of time spent under the scan. The use of contrast enhanced images should be limited, as the contrast may diffuse over time and limit the value of information on subsequent scans. The other chapters discuss the use of iMRI for intraoperative functional MRI and diffusion-weighted images with tractography to visualize eloquent structures during surgical resection. The other sections deal with the use of intraoperative MRI for confirmation of satisfactory placement of depth electrodes, ensuring completeness of lesional resections and callosotomy in patients with intractable epilepsy, vascular lesions like cavernomas.

The world of intraoperative MRI technology is changing rapidly, and newer applications are on the horizon. This book highlights some of these which include the use of robotic devices and manipulators which help obviate the restrictions MRI imposes on the use of mechanical devices around scanners. These robots made from MRI compatible materials use hydraulic, pneumatic or ultrasonic motors that can be manipulated remotely.

The technology in these areas is evolving.

Introduction

Intraoperative MRI may also be used for MRI guided laser probe delivered or ultrasound mediated thermal ablation of small brain tumors or focal putative epileptogenic foci. These new modalities can deliver focused energy resulting in thermal ablation of involved neural tissue. Temperature-sensitive imaging MR techniques can help monitor the extent of thermal injury created. The size and shape can be conformed to the 3D extent of the tumor or lesion under consideration.

Other techniques include molecular imaging, PET scanning using newer isotopes, optical imaging using fluorescence-based agents. Use of these newer technologies has resulted in the need for integration of various imaging modalities in the same operating environment. Newer operating rooms are being developed to accommodate these evolving needs and facilitate the use of robotic devices in neurosurgery.