Introduction: Intraoperative MRI has demonstrated efficacy in the surgical treatment of intracranial tumors. However, advances in technology have allowed newer systems to be used outside of traditional research institutions. With the potential that more surgical procedures could benefit from intraoperative imaging, this study reviews its impact on a general neurosurgical population.
Methods: The intraoperative MRI at Wilkes-Barre General Hospital was one of the first high field units in the United States and was installed in a community hospital. All neurosurgical cases utilizing intraoperative MRI between 6/2006 and 3/2013 at this institution were reviewed. Information on procedure type, complications, outcomes, and whether imaging changed surgical decision making was collected.
Results: One hundred ninety five surgeries were performed during the review period. Of these, 104 were cranial and 91 were cervical. Eighty one of the cranial surgeries were tumor resections. In 26, imaging data lead to additional debulking of residual tumor. In vascular surgeries, imaging confirmed perfusion following 4 aneurysm clippings and no residual nidus following 3 AVM resections. In two Chiari decompressions, there was increased posterior fossa subarachnoid space following craniectomy and duroplasty was not performed. Of 91 cervical cases, seventy-seven were for one or two level anterior cervical diskectomies. In one of these, an additional level diskectomy was not performed because imaging showed less severe myelomalacia than the preoperative scan. In another case, intraoperative imaging allowed localization of an intrinsic cervical cord tumor. There were no complications related to the MRI.
Conclusions: Intraoperative MRI can be applied to neurosurgical procedures involving the cranium and cervical spine. This review showed its greatest usefulness was in improving tumor resection. There was also utility in visualizing perfusion in vascular cases, posterior fossa anatomy in Chiari decompressions, and intramedullary lesions in cervical surgeries.
Patient Care: Expand the indications for using intraoperative MRI outside the field of tumor surgery.
Learning Objectives: By the conclusion of this session, participants should be able to:
1) Understand which neurosurgical procedures could benefit from intraoperative MRI,
2) The limitations of intraoperative imaging,
3) The current role for intraoperative imaging in a neurosurgery.