Intraoperative magnetic resonance imaging guidance for intracranial neurosurgical procedures

A 0.5 Tesla open configuration magnetic resonance imaging (MRI) system (Sig na SP [GE Medical Systems; Milwaukee, Wi]) is sited in an operating room en vironment at Brigham and Women's Hospital for MRI-guided surgical and inter ventional procedures. The vertical gap provides patient access to two surge ons or interventionalists, whereas open flexible transmit-receive coils all ow exposure of the surgical field. A major application of this system at Br igham and Women's Hospital is intraoperative MRI guidance for intracranial biopsies and open craniotomies. During the past 21/2 years, more than 200 i ntracranial procedures have been performed using intraoperative MRI guidanc e. For intracranial biopsies, MRI guidance provides several advantages, inc luding high sensitivity for lesion localization; interactive navigation, el iminating the need for a stereotactic frame; multiplanar image confirmation of biopsy site location; and early detection of complications. Based on ou r experience with open craniotomies, we think that image guidance significa ntly improves the ability of the neurosurgeon to resect abnormal tissue sel ectively while preserving adjacent eloquent areas. Furthermore, our experie nce indicates that intraoperative imaging offers advantages over convention al stereotactic image guidance, including the ability to compensate for shi fts in brain position during surgery, and allows for early identification o f complications. Intraoperative MRI-guided neurosurgery is a multidisciplin ary effort involving the neurosurgeon, neuroradiologist, technologist, nurs ing staff, and engineers. In our experience, there is little doubt that MRI guidance improves the technical aspects of the neurosurgical procedures; h owever, the impact of this technology on clinical outcomes and cost effecti veness await further study.