How to implement high-field intraoperative magnetic resonance imaging
The purpose of this study is to develop a new setup for intraoperative imaging that combines the benefits of high-field magnetic resonance (MR) imaging with microscope-based neuronavigation, providing anatomical and functional guidance. Our concept is bas
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How to implement high-field intraoperative magnetic resonance imaging Ch. Nimskya, O. Ganslandta, R. Fahlbusch a a Department of Neurosurgery, University Erlangen-Nuremberg, Schwabachanlage 6, 91054 Erlangen, Germany
Abstract The purpose of this study is to develop a new setup for intraoperative imaging that combines the benefits of high-field magnetic resonance (MR) imaging with microscopebased neuronavigation, providing anatomical and functional guidance. Our concept is based on this combination of intraoperative MR imaging evaluating the extent of a resection, while the simultaneous use of functional neuronavigation with integrated data from magnetoencephalography and functional MR imaging, allows to localize eloquent brain areas in the operative field. Thus, preventing increased neurological deficits, which could otherwise result from extended resections, if they were based only on the evaluation by intraoperative MR imaging. Keywords: Functional data, intraoperative magnetic resonance imaging, neuronavigation.
1. Purpose In the last S years we performed intraoperative MR imaging using a low-field 0.2 Tesla scanner in 330 patients [1-3]. The main indications were the evaluation of the extent of resection in gliomas, pituitary tumors [4], and in epilepsy surgery [S]. The initial concept provided three different operating setups: directly in the scanner for interventional procedures, at the SG-line, the patient still placed on the movable MR tray, or in an adjacent operating room, necessitating intraoperative patient transport. This cumbersome intraoperative patient transport on an air-cushioned OR-table was abandoned when microscope-based neuronavigation could be performed in the fringe-field of the scanner using a new navigation microscope [2]. We performed surgery at the S G line in 164 patients, while intraoperative patient transport was applied in 166 patients. In 167 patients neuronavigational guidance was used, while additionally functional data from magnetoencephalography or fMRI were integrated in 6S. The simultaneous use of functional navigation prevented additional neurological deficits [6-10]. Intraoperative MR imaging offered the possibility of further tumor removal during the same surgical procedure in case of tumor remnants, increasing the rate of complete tumor removal. Furthermore, the effects of brain shift could be compensated for by updating neuronavigation with intraoperative image data [11-13]. Compared to routine pre- or postoperative imaging, being performed with high-Tesla machines, intraoperative image quality and sequence spectrum could not compete with those. This lead to the development of a new concept to adapt a high-field MR scanner to
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140 our operating environment, preserving the benefits of using standard microsurgical equipment and microscope-based neuronavigational guidance with integrated functional data. Active magnetic shielding of m
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