Interactive magnetic resonance imaging-guided management of intracranial cystic lesions by using an open magnetic resonance imaging system

Object. The authors present their experience with neurosurgical procedures requiring real-time imaging feedback such as aspiration of a cystic structu re or abscess cavity, decompression of hydrocephalic ventricles, management of arachnoid cysts, and installation of permanent or temporary drainage co nduits, in which interactive magnetic resonance (MR) imaging guidance was u sed to monitor structural alterations associated with the procedure. Methods. Drainage of eight intraparenchymal brain abscesses in seven patien ts, decompression of space-occupying cystic or necrotic brain tumors in fou r patients, and endoscopic management of hydrocephalus associated with arac hnoid cysts in three patients were performed using MR imaging-guided framel ess stereotaxy in an open-configuration 0.5-tesla superconducting MR imagin g system. Intraoperative MR imaging guidance provided accurate information on the cou rse of the surgical procedure and associated intraoperative changes in tiss ue position, such as the degree of cyst aspiration, the presence or absence of hemorrhage or induced swelling, and changes associated with decompressi on of adjacent brain parenchyma and the ventricular system. No clinically s ignificant complications were encountered in any patient. There were no tar geting errors, and procedural objectives were accomplished in all cases. Conclusions. Drainage of brain abscesses, punctures of cystic or necrotic i ntracranial lesions with subsequent aspiration, and management of hydroceph alus can be performed safely and accurately by monitoring the procedure usi ng real-time MR imaging to obtain immediate feedback on associated dynamic tissue changes.