Magnetic Resonance Imaging-guided Neurosurgery in the Magnetic Fringe Fields: The Next Step in Neuronavigation

Abstract

Full neurosurgical procedures may be performed in the weak fringe fields surrounding an MRI system, using standard operating room equipment. This approach to iMR-guided neurosurgery offers a significant cost advantage over retrofitting an entire operative suite with "MRI-compatible" surgical equipment. The surgeon's familiarity with standard equipment and the reliability of the equipment are additional advantages. Neurosurgery in the fringe fields allows the neurosurgeon to utilize serial MRI with a minimum of inconvenience, disruption, and change to the standard neurosurgical procedure. Serial intraoperative imaging to visualize the changes in the brain that are associated with neurosurgical intervention seems to enhance the ability to safely and effectively accomplish neurosurgical goals.

Standardization of Amygdalohippocampectomy with Intraoperative Magnetic Resonance Imaging: Preliminary Experience

“…This system uses a 0.5-T "double donut" magnet (GE Medical Systems, Milwaukee WI, U.S.A.), in which the surgeons operated with nonferromagnetic equipment. Several "low-field" systems are currently operational based on 0.2-and 0.3-T magnets (32,34,35,38,39). Surgeries are either performed within the magnet using nonferromagnetic equipment, in adjacent rooms using standard instrumentation, or near the magnet in the "fringe-fields," where standard instrumentation may be used.…”

“…Since its introduction into clinical practice in 1994, IMRI has been used in >1,000 documented patients, predominantly for the treatment of intracranial neoplasms (29)(30)(31)(32)(34)(35)(36)(37)(38)(39)(40)(41). Few reports document the utility of IMRI for temporal lobectomy and radical amygdalohip- (32,40).…”

“…Since the installation of the first unit at Brigham and Woman's Hospital in 1994 (29), several low-field and high-field models have been developed, and preliminary experience has been published (30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41). We investigated the utility of IMRI in maximizing and standardizing the medial temporal lobe resection for medically intractable epilepsy, an operation in which the extent of resection clearly affects the outcome of the surgical treatment.…”

A Head-Mounted Display System for Augmented Reality Image Guidance: Towards Clinical Evaluation for iMRI-guided Nuerosurgery

“…We are currently preparing our AR system for use in UCLA's neurosurgical iMR operating room [14]. The patient's bed can be placed in the magnet's fringe field for the surgical procedure or swiveled into the magnet for MR scanning.…”

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

“…The main advantage of MRI over other modalities is that it combines excellent contrast, multiplanar capabilities, and the absence of ionizing radiation. Various MR-guided approaches involving minimal patient transfer have been pursued successfully, predominantly in the neurosurgical domain (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18). In a moderate departure from a conventional setting, an interventional MRI (iMRI) environment was built in line with a diagnostic 1.5 T scanner (5), which kept both functional (i.e., functional MRI (fMRI) and perfusionand diffusion-weighted imaging) and spectroscopic imaging options open.…”