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65th Annual Meeting of the German Society of Neurosurgery (DGNC)

German Society of Neurosurgery (DGNC)

11 - 14 May 2014, Dresden

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Implementation of intraoperative 3 Tesla MRI-guided intracerebral tumor resection in a two-room concept

Meeting Abstract

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  • Oliver Bozinov - Klinik für Neurochirurgie, Universitätsspital Zürich, Zürich, Schweiz
  • Jan-Karl Burkhardt - Klinik für Neurochirurgie, Universitätsspital Zürich, Zürich, Schweiz
  • Marian C. Neidert - Klinik für Neurochirurgie, Universitätsspital Zürich, Zürich, Schweiz
  • Jorn Fierstra - Klinik für Neurochirurgie, Universitätsspital Zürich, Zürich, Schweiz
  • Luca Regli - Klinik für Neurochirurgie, Universitätsspital Zürich, Zürich, Schweiz

Deutsche Gesellschaft für Neurochirurgie. 65. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC). Dresden, 11.-14.05.2014. Düsseldorf: German Medical Science GMS Publishing House; 2014. DocDI.14.12

doi: 10.3205/14dgnc205, urn:nbn:de:0183-14dgnc2058

Published: May 13, 2014

© 2014 Bozinov et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

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Objective: Intraoperative 3 Tesla MRI (io3T MRI) has been implemented in our hospital with the rationale to increase tumor resection grade and correct for brain shift to thereby increase adequacy of surgery. However, implementing an io3T MRI system poses technical challenges, such as an inferior signal-to-noise quality due to the ioMRI head coil or intracranial air during an open surgical approach strategy. Also, a meticulous checklist has to be developed to assure patient safety, coordination between the interdisciplinary teams involved, and to achieve the highest image quality possible to make it comparable with a conventional cerebral 3T MRI examination.

Method: Observational study with enrollment of all patients that underwent an io3T MRI examination (Skyra, Siemens) during intracerebral tumor resection between 03/2013 to10/2013. We evaluated the implemented checklists, patient safety, adverse events, transfer and imaging time and image quality.

Results: A total of 35 patients including 20 gliomas (WHO Grade I n=3, II n= 3, III n= 9, and IV n= 6), 10 pituitary adenomas, 2 epidermoid cysts, 1 intracerebral metastasis and 1 PNET underwent io3TMRI examination during this period. In 33 patients (transcranial n=23 and transnasal n=10) intraoperative imaging was possible and safe without any reported adverse events. Tumor specific MRI sequences (T1 postcontrast, T2, FLAIR, diffusion weighted volumes) could be obtained in imaging quality comparable to a conventional 3T MRI examination. In 1 patient the transfer process was extended due to a technical problem of the docking procedure and in 1 small child the planned MRI scan needed to be canceled due to dislocation of the intubation tube during initial transfer.

Conclusions: Io3T MRI examination during intracerebral tumor resection was feasible and safe with an imaging quality comparable to that of a conventional 3T MRI examination in most patients. However, prone positioning in very small patients can be challenging in a transfer setting.