Intraoperative imaging with open magnetic resonance imaging and neuronavigation.

The Erlangen-concept of image-guided-surgery is based on the installation of an open magnetic resonance (MR) scanner (Magnetom Open, 0.2 T, Siemens AG) in a twin operating room in combination with two neuronavigation systems (Stealth NeuroStation, Sofamor Danek, MKM Zeiss). Since March 1996 this method has been used for a total of 402 patients, among them 44 children. In 214 patients, mainly with gliomas or pituitary adenomas or who needed surgery for epilepsy, we performed intraoperative MR imaging to monitor the extent of resection, allowing a second look for possible tumor remnants and also compensating for brain shift by an intraoperative update of neuronavigation. Functional neuronavigation, i.e. the combination of anatomical neuronavigation with functional imaging [e.g. magnetoencephalography (MEG) and functional magnetic resonance imaging (fMRI)] was used in patients with lesions in brain areas such as the motor and speech areas. For MEG we used a MAGNES II biomagnetometer (Biomagnetic Technologies, San Diego, Calif.) and for fMRI a 1.5 T Siemens Symphony MR scanner. So far we have treated 89 patients with functional neuronavigation. Our preliminary experience indicates that intraoperative MR imaging, especially in combination with functional neuronavigation, allows more radical resections with lower morbidity.