Article
Safety, value and feasibility of continous intraoperative electrophysiological monitoring in 1.5T iMRI-guided surgery
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Authors
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Constantin Roder
- Universitätsklinikum Tübingen, Klinik für Neurochirurgie, Tübingen, Deutschland
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Martin Breitkopf
- Universitätsklinikum Tübingen, Klinik für Neurochirurgie, Tübingen, Deutschland
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Sotirios Bisdas
- Universitätsklinikum Tübingen, Department Radiologie, Diagnostische und Interventionelle Neuroradiologie, Tübingen, Deutschland
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Marina Liebsch
- Universitätsklinikum Tübingen, Klinik für Neurochirurgie, Tübingen, Deutschland
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Felix Behling
- Universitätsklinikum Tübingen, Klinik für Neurochirurgie, Tübingen, Deutschland
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Marcos Tatagiba
- Universitätsklinikum Tübingen, Klinik für Neurochirurgie, Tübingen, Deutschland
| Published: | June 9, 2017 |
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Outline
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Objective: The combined use of intraoperative high-field MRI (iMRI) and electrophysiological monitoring (IOM) is often not applied on a routine basis due to concerns on possible side-effects. This is mainly based on sorrow to leave the skin-electrodes in-situ for intraoperative scanning, as burnings might occur and the magnetic field might disturb the fine electrical currents needed for proper neuromonitoring. However, if used together, both technologies might bring significant advantages for the treatment of patients. Therefore we have evaluated the safety and results of the combined use of both technologies.
Methods: The setup, surgical, imaging and clinical results of 110 patients with eloquent intracranial lesions with the combined use of 1.5T iMRI and IOM were analyzed.
Results: 187 iMRI scans were performed with straight Platinum/Iridium IOM needles in place, resulting in a total experience of using more than 4000 electrodes in the iMRI. No complication (ferromagnetic or relevant heating/burning of skin) was caused by the combined use of both technologies. MR imaging quality was not influenced by leaving the electrodes in situ. Surgically induced severe postoperative sensorimotor deficits were seen in in 11.8%. The surgeon’s intraoperative estimation of a “complete resection” proved to be true postoperatively in 90.3%. If the resection was stopped due to worsening of IOM, postoperative MRI revealed residual disease to be located in direct vicinity of eloquence in 27 of 28 cases, but not in other parts of the resection cavity. Of these patients, only 7% (2 of 28) had relevant new persisting neurological deficits after 3 months. In 82 (74.5%) of all patients the resection was continued after the iMRI scan, whereat in only 18 (16.4%) the resection was already completed at this point. In addition to proving safety and efficiency of both technologies, we have photo-documented special pitfalls in positioning of electrodes and cables to ensure a safe treatment.
Conclusion: The combined use of IOM and 1.5T iMRI is feasible and safe, if complications are avoided by careful preparation of each patient. The complementary use of both technologies might result in more radical resections at comparable surgically-induced neurological deficits. If available and indicated, the combined use of IOM and iMRI should be performed on a routine basis.
