Artikel
Intraoperative high-field magnetic resonance imaging, multimodal navigation and intraoperative electrophysiological monitoring guided surgical treatment of cerebrovascular diseases
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Autoren
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Fang-ye Li
- Department of Neurosurgery, PLA General Hospital, Beijing, China
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Xiao-lei Chen
- Department of Neurosurgery, PLA General Hospital, Beijing, China
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Guo-chen Sun
- Department of Neurosurgery, PLA General Hospital, Beijing, China
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Jia-shu Zhang
- Department of Neurosurgery, PLA General Hospital, Beijing, China
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Jin-jiang Li
- Department of Neurosurgery, PLA General Hospital, Beijing, China
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Gang Zheng
- Department of Neurosurgery, PLA General Hospital, Beijing, China
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Ting Zhang
- Department of Neurosurgery, PLA General Hospital, Beijing, China
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Bai-Nan Xu
- Department of Neurosurgery, PLA General Hospital, Beijing, China
| Veröffentlicht: | 21. Mai 2013 |
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Gliederung
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Objective: Clinical application of intraoperative high-field magnetic resonance imaging (iMRI) and multimodal navigation in treatment of cerebrovascular diseases has been rarely reported. To systematically document the beneficial effect of intraoperative high-field MRI, multimodal navigation and intraoperative electrophysiological monitoring in surgical treatment of selected cerebrovascular diseases.
Method: Thirty-one patients with cerebrovascular diseases (13 supratentorial cavernomas, 11 brainstem cavernomas, 6 arteriovenous malformations (AVMs) and 2 distal aneurysms) were prospectively enrolled and operated with 1.5 T intraoperative MRI, multimodal navigation and intraoperative electrophysiological monitoring. All cavernomas were small (<2 cm), subcortically deep-seated or involving critical areas, while all AVMs involved eloquent structures. Intraoperative high-field MRI was obtained for intraoperative “visualization” of surrounding eloquent structures, “brain shift” correction, and navigational plan update.
Results: All cavernomas and AVMs were successfully resected with iMRI, multimodal navigation and intraoperative electrophysiological monitoring. In 5 cases with supratentorial cavernomas, intraoperative “brain shift” severely interfered with determining the location of the lesions. Intraoperative MR imaging helped to precisely relocate the lesion. In 1 brainstem cavernoma, the first intraoperative MRI scan demonstrated a lesion remnant, which needed further resection. Two distal aneurysms were successfully clipped with multimodal navigation. Intraoperative MRI excluded any intracranial hemorrhage or hyperacute infarction. Some or all presenting signs and symptoms improved or resolved in 18 cases during long-term (>3 months) follow-up.
Conclusions: Intraoperative high-field MRI, multimodal navigation and intraoperative electrophysiological monitoring are helpful for surgical treatment of selected cerebrovascular diseases, such as small subcortically deep-seated cavernomas or AVMs involving eloquent structures, as well as selected distal aneurysms.
