Advanced approach for intraoperative MRI guidance and potential benefit for neurosurgical applications

Abstract

Purpose: To present an advanced approach for intraoperative image guidance in an open 0.5 T MRI and to evaluate its effectiveness for neurosurgical interventions by comparison with a dynamic scan-guided localization technique. Materials and Methods:The built-in scan guidance mode relied on successive interactive MRI scans. The additional advanced mode provided real-time navigation based on reformatted high-quality, intraoperatively acquired MR reference data, allowed multimodal image fusion, and used the successive scans of the built-in mode for quick verification of the position only. Analysis involved tumor resections and biopsies in either scan guidance (N ϭ 36) or advanced mode (N ϭ 59) by the same three neurosurgeons. Technical, surgical, and workflow aspects were compared. Results:The image quality and hand-eye coordination of the advanced approach were improved. While the average extent of resection, neurologic outcome after functional MRI (fMRI) integration, and diagnostic yield appeared to be slightly better under advanced guidance, particularly for the main surgeon, statistical analysis revealed no significant differences. Resection times were comparable, while biopsies took around 30 minutes longer. Conclusion:The presented approach is safe and provides more detailed images and higher navigation speed at the expense of actuality. The surgical outcome achieved with advanced guidance is (at least) as good as that obtained with dynamic scan guidance.

Intraoperative Visualization of Fiber Tracking Based Reconstruction of Language Pathways in Glioma Surgery

“…19,20 Our results of postoperative morbidity regarding language deficits are Other studies evaluated the influence of iMRI resection control on EOR in glioma surgery, including a volumetric analysis of tumor volume, which also showed similar results for EOR and the influence of iMRI. Intraoperative low-field MRI was used by Busse et al, 28 Bohinski et al, 29 and Schneider et al 30 Busse et al 28 reported gross-total glioma resection in 22.7%. Bohinski et al 29 reported that gross total resection (GTR) was enhanced from 47% to 72.5% after iMRI and continued surgery.…”

Navigation concepts for MR image‐guided interventions

“…In open scanners with add‐on systems, the virtual navigation scene may be displayed simultaneously with the continuously scanned MR image on two in‐bore monitors (36, 40–42). Such a synchronized view of both visualization modes during a brain biopsy procedure is illustrated in Fig.…”

“…In a subsequent step, the functional information is then overlaid on the respective intraoperative image (41). Besides the simple landmark or marker‐based techniques, automatic coregistration methods using statistical image measures such as mutual information are also widely available (36, 40–42). Over the past years these techniques have also been successfully applied in various clinical fields.…”

201 Intraoperative Cerebral Glioma Characterization With Contrast Enhanced Ultrasound

“…Complete tumor resection remains the best treatment option as long as it can be achieved without neurological sequelae. The role of imaging techniques in surgical resection of brain lesions is crucial in every step of surgery: they help planning surgical strategy, provide orientation during surgery, and indicate tumor boundaries and relationships with eloquent areas and vital structures, thus enhancing precision, accuracy, and safety for the patients while maximizing resection [1][2][3][4]. In recent years we are witnessing an increased use of ultrasounds (US) in neurosurgery, as their reliability as an intraoperative tool for tumor detection has been shown in multiple studies [5][6][7][8][9].…”