gms | German Medical Science

Objective: The increase implementation of intraoperative MRI and neuromonitoring leads also to combined use. In high field MRI environment these needles for stimulation can cause trouble. We describe possible complications of interactions.

Methods: We followed all consecutive surgeries with the combined intraoperative use of monitoring and 3T MRI over a 4-year period. Previously tested Platinum needles were used on the scalp and standard needles on the body. Needles placed in the head and on the body, were checked for skin burns (grade 1-4). The needles stayed in place for continued neuromonitoring after the intraoperative MRI.

Results: Overall, more than 500 needles were placed on the scalp and around 1000 needles on the body for SEP and MEPs as well as for cranial nerve testing. Altogether, 5 critical incidences occurred. 3 were minor skin burns on the shoulder (grade 1 and 2) and one skin burn (grade 3) on the scalp. The worst skin burn happened with a new MRI certified needle. A very special incident occurred for cranial nerve monitoring with a non-tested needle, which resulted in temporary corneal defect.

Conclusion: Combined used of neuromonitoring and intraoperative MRI is not completely safe and complications occur in less than 0.5% for every needle. However, this new experience has to be shared and demonstrated. Further improvements are necessary and combined use has to be selected only when critical for good outcome.