Initial experience of using high field strength intraoperative MRI for neurosurgical procedures

Raheja, Amol; Tandon, Vivek; Suri, Ashish; Chandra, P. Sarat; Kale, Shashank S.; Garg, Ajay; Pandey, Ravindra Mohan; Kalaivani, Mani; Mahapatra, Ashok Kumar; Sharma, Bhawani S.

doi:10.1016/j.jocn.2015.02.027

Cited by 12 publications

(8 citation statements)

References 18 publications

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“…The included manuscripts mainly consisted of informal (non-systematic) reviews (n=10) [2][3][4][5][6][25][26][27][28][29], institutional experiences (n=10) [30][31][32][33][34][35][36][37][38][39], and case series/retrospective studies (n=12) [40][41][42][43][44][45][46][47][48][49][50][51], with only a few prospective studies (n=4) [52][53][54][55]. We also included 11 references that were published only in abstract form [56][57][58][59][60][61] or case report format [62][63][64][65][66].…”

Section: Resultsmentioning

confidence: 99%

“…The definition for those was again heterogeneous, from inability to perform the scan or difficulty with coil positioning to software problems causing imaging delays and problems during operating room table movement. One study demonstrated a significant decrease in the occurrence of technical problems in the last 100 of 300 consecutive patients, compared to the first 100 (3 vs. 31, p<0.001) [48].…”

Section: Adverse Events During Cases With Imrimentioning

confidence: 97%

“…Seventeen manuscripts reported data on adverse events from a total of 2520 cases, which can be further divided into the following broad categories: adverse anesthesia or clinical events (reported in 12 manuscripts, including a total of 1955 cases) [40][41][42][43][44][45][46]53,[55][56][57][58], MRI-related adverse events (reported in 7 manuscripts, including a total of 889 cases) [42,43,[46][47][48]57,59], or technical problems (reported in 5 manuscripts, including a total of 535 cases) [47][48][49]51,53]. We did not examine surgical adverse outcomes or complications, even though those were addressed in some of the included manuscripts, because our research question focused on anesthetic considerations.…”

Section: Adverse Events During Cases With Imrimentioning

confidence: 99%

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Anesthetic challenges and outcomes for procedures in the intraoperative magnetic resonance imaging suite: A systematic review

Schroeck

Welch

Rovner

et al. 2019

Journal of Clinical Anesthesia

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Background and objective: Hybrid operating room suites with intraoperative magnetic resonance imaging enable image guided surgery in a fully functional operating room environment. While this environment creates challenges to anesthetic care, the effects on anesthetic adverse events and outcomes are largely unknown. This systematic scoping review aims to map the existing knowledge about anesthetic care in advanced imaging hybrid operating rooms. Methods: A broad-based literature search was performed using the PubMed (Medline), Embase, Cochrane Library, Web of Science, and Google Scholar databases. References published in English between January 1994 and August 2017 were included. Quality of evidence was assessed using the GRADE guidelines.

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Section: Resultsmentioning

confidence: 99%

Section: Adverse Events During Cases With Imrimentioning

confidence: 97%

Section: Adverse Events During Cases With Imrimentioning

confidence: 99%

See 1 more Smart Citation

Anesthetic challenges and outcomes for procedures in the intraoperative magnetic resonance imaging suite: A systematic review

Schroeck

Welch

Rovner

et al. 2019

Journal of Clinical Anesthesia

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“…Adaptation of MRI scans to the surgical suite increases the accuracy of tumor delineation and the extent of glioma resection. The incidence of complete tumor resection was significantly higher using intraoperative MRI with no increase in neurological deficits compared to conventional surgery ( p = 0.023) ( 13 , 14 ). The intraoperative MRI is inconvenient due to its bulky coil that encroaches on limited surgical space, and its strong magnetic field requires MRI compatible tools and supplies when surgery is performed in the magnetic field ( 15 , 16 ).…”

Section: Intraoperative Delineation Of Gliomasmentioning

confidence: 98%

The Art of Intraoperative Glioma Identification

et al. 2015

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A major dilemma in brain-tumor surgery is the identification of tumor boundaries to maximize tumor excision and minimize postoperative neurological damage. Gliomas, especially low-grade tumors, and normal brain have a similar color and texture, which poses a challenge to the neurosurgeon. Advances in glioma resection techniques combine the experience of the neurosurgeon and various advanced technologies. Intraoperative methods to delineate gliomas from normal tissue consist of (1) image-based navigation, (2) intraoperative sampling, (3) electrophysiological monitoring, and (4) enhanced visual tumor demarcation. The advantages and disadvantages of each technique are discussed. A combination of these methods is becoming widely accepted in routine glioma surgery. Gross total resection in conjunction with radiation, chemotherapy, or immune/gene therapy may increase the rates of cure in this devastating disease.

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“…In our initial experience of using iMRI, we have reported "iMRI increased the EOR in 59.7% (40/67) of patients who underwent iMRI." 10 Hughes Duffau from Montpellier and Mitch Berger from San Francisco have advocated awake craniotomy for intraoperative functional mapping and preserving function. There is no doubt that the use of this technique is helpful in preservation of function, but it comes at a cost of larger craniotomies.…”

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confidence: 99%

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2017

IJNS

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Indian J Neurosurg 2017;6:159-162.Neurosurgeons since time immemorial have been in search of an ideal navigational tool, which can help them plan, localize a lesion, and provide real-time guidance. Development of image-guided navigation systems improved the localizing ability, but major drawback of these systems was absence of real-time guidance. After craniotomy, tumor decompression, or cerebrospinal fluid (CSF) release, there is brain shift. Conventional navigation systems work on preoperatively acquired images of computed tomography scan (CTS) or magnetic resonance imaging (MRI). Preoperative data can usually help a surgeon plan and localize a lesion, but during surgery its utility is limited. Intraoperative imaging is required to update and recalibrate the navigation system to account for the brain shift. This can be done using ultrasound (USG), CTS, or MRI. USG is a cheaper alternative than the other two, but the quality of imaging is inferior. Moreover, it is a user-dependent technology. Similarly, CTS cannot discern brain tumor interface in all patients. Therefore, its utility for brain tumor surgery is limited. MRI provides excellent quality of images. It can help surgeons in improving their extent of resection (EOR) by targeting the residual lesion after acquiring intraoperative scan. The other advantage of intraoperative MRI (iMRI) is avoidance of nonionizing radiation. Because of these reasons, research and developments in this field happened at a faster pace. The Departments of Neurosurgery and Radiology of the Brigham and Woman's Hospital at Harvard Medical School in Boston and the General Electric Medical System developed the first iMRI in 1991. In 1994, the first prototype was installed at the Brigham and Woman's Hospital. It was a 0.5 Tesla MRI system with a doughnut-type magnet in which a gap was left between the coils of the magnet for the surgeon to stand and position the patient. 1 This had its own share of disadvantages, as MRI-compatible operative instruments, microscopes, and anesthesia machines were required. Realization of the fact that ergonomics of patient and surgeon's positioning for complex and long surgeries is more important than continuous need for MRI led to further developments. Siemens came up with the concept of "twin operating theater," where surgery will be performed in one suite and then the patient can be transported to other room. Thus, surgery could be performed with usual instruments. However, the first magnet used for such "twin room theater" was a 0.2 Tesla field of Magnetom Open system. The disadvantages of this system included increased duration of surgery due to 20 to 40 minutes being utilized in transportation of the patient, poor-quality images from 0.2 Tesla magnet, and higher installation costs as two separate rooms had to be built. 2 Sutherland in 1999 developed a suite, which allowed surgery to be performed in a standard operating room (OR) while magnet was stored separately in a closed-door room. This ceiling mounted magnet could be brought into the OR, whe...

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Initial experience of using high field strength intraoperative MRI for neurosurgical procedures

Cited by 12 publications

References 18 publications

Anesthetic challenges and outcomes for procedures in the intraoperative magnetic resonance imaging suite: A systematic review

Anesthetic challenges and outcomes for procedures in the intraoperative magnetic resonance imaging suite: A systematic review

The Art of Intraoperative Glioma Identification

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