OBJECTIVE: To apply a new setup, combining the benefits of high-field magnetic resonance imaging (MRI) with microscope-based neuronavigation, providing anatomical and functional guidance, in glioma surgery. MATERIAL AND METHODS: MR imaging was performed using a 1.5 T scanner, located in a radiofrequency-shielded operating theatre. The patient is lying on a rotating operating table, which is locked at the 160 degree position for surgery at the 5 G zone and turned into the scanner for imaging. The microscope, placed in the 5 G zone, in combination with a ceiling mounted navigation system enables microscope-based neuronavigation; integrated data from magnetoencephalography and functional MRI provide functional guidance. RESULTS: 126 patients were investigated with intraoperative high-field MRI, among them were 37 patients with gliomas. In the biopsy/catheter group (n = 8) MRI reliably depicted the needle position or the location of catheter placement. In the group with glioma resection (n = 29) intraoperative MRI revealed that the surgical objective was not achieved in 28%, leading to further tumour removal. We did not observe complications attributable to intraoperative high-field MRI. Image quality was not diminished by the operating room equipment, so that there was nearly no noticeable difference between pre- and intraoperative image quality. Neuronavigational guidance was applied in 31 patients: the integrated use of functional data prevented an increased morbidity despite extended resections. CONCLUSION: Intraoperative high-field MRI allows a reliable delineation of the extent of resection in glioma surgery. If the surgical objective was not met, a modification of the surgical strategy during the same operation is possible, thus leading to more radical resections. Furthermore, high-field MRI offers increased image quality and a much broader spectrum of different imaging modalities, compared to previous intraoperative low-field systems.
OBJECTIVE: To apply a new setup, combining the benefits of high-field magnetic resonance imaging (MRI) with microscope-based neuronavigation, providing anatomical and functional guidance, in glioma surgery. MATERIAL AND METHODS: MR imaging was performed using a 1.5 T scanner, located in a radiofrequency-shielded operating theatre. The patient is lying on a rotating operating table, which is locked at the 160 degree position for surgery at the 5 G zone and turned into the scanner for imaging. The microscope, placed in the 5 G zone, in combination with a ceiling mounted navigation system enables microscope-based neuronavigation; integrated data from magnetoencephalography and functional MRI provide functional guidance. RESULTS: 126 patients were investigated with intraoperative high-field MRI, among them were 37 patients with gliomas. In the biopsy/catheter group (n = 8) MRI reliably depicted the needle position or the location of catheter placement. In the group with glioma resection (n = 29) intraoperative MRI revealed that the surgical objective was not achieved in 28%, leading to further tumour removal. We did not observe complications attributable to intraoperative high-field MRI. Image quality was not diminished by the operating room equipment, so that there was nearly no noticeable difference between pre- and intraoperative image quality. Neuronavigational guidance was applied in 31 patients: the integrated use of functional data prevented an increased morbidity despite extended resections. CONCLUSION: Intraoperative high-field MRI allows a reliable delineation of the extent of resection in glioma surgery. If the surgical objective was not met, a modification of the surgical strategy during the same operation is possible, thus leading to more radical resections. Furthermore, high-field MRI offers increased image quality and a much broader spectrum of different imaging modalities, compared to previous intraoperative low-field systems.
Authors: Nathan S White; Carrie McDonald; Carrie R McDonald; Niky Farid; Josh Kuperman; David Karow; Natalie M Schenker-Ahmed; Hauke Bartsch; Rebecca Rakow-Penner; Dominic Holland; Ahmed Shabaik; Atle Bjørnerud; Tuva Hope; Jona Hattangadi-Gluth; Michael Liss; J Kellogg Parsons; Clark C Chen; Steve Raman; Daniel Margolis; Robert E Reiter; Leonard Marks; Santosh Kesari; Arno J Mundt; Christopher J Kane; Christopher J Kaine; Bob S Carter; William G Bradley; Anders M Dale Journal: Cancer Res Date: 2014-09-01 Impact factor: 12.701
Authors: C R McDonald; N S White; N Farid; G Lai; J M Kuperman; H Bartsch; D J Hagler; S Kesari; B S Carter; C C Chen; A M Dale Journal: AJNR Am J Neuroradiol Date: 2012-12-28 Impact factor: 3.825
Authors: P W A Willems; J W Berkelbach van der Sprenkel; C A F Tulleken; M A Viergever; M J B Taphoorn Journal: J Neurol Date: 2006-09-20 Impact factor: 4.849
Authors: Vanja Varenika; Peter Dickinson; John Bringas; Richard LeCouteur; Robert Higgins; John Park; Massimo Fiandaca; Mitchel Berger; John Sampson; Krystof Bankiewicz Journal: J Neurosurg Date: 2008-11 Impact factor: 5.115