Review of first clinical experiences with a 1.5 Tesla ceiling-mounted moveable intraoperative MRI system in Europe

Guenther C. Feigl; Stefan Heckl; Marcel Kullmann; Zoltan Filip; Karlheinz Decker; Jan Klein; Ulrike Ernemann; Marcos Tatagiba; Tomaz Velnar; Rainer Ritz

doi:10.17305/bjbms.2018.3777

Authors

Guenther C. Feigl Department of Neurosurgery, University of Tuebingen Medical Center, Germany
Stefan Heckl Department of Neuroradiology, University of Tuebingen Medical Center, Germany
Marcel Kullmann Department of Neurosurgery, University of Tuebingen Medical Center, Germany
Zoltan Filip Department of Anesthesiology, University of Tuebingen Medical Center, Germany
Karlheinz Decker Department of Anesthesiology, University of Tuebingen Medical Center, Germany
Jan Klein Institute for Medical Image Computing, Fraunhofer MEVIS Bremen, Germany
Ulrike Ernemann Department of Neuroradiology, University of Tuebingen Medical Center, Germany
Marcos Tatagiba Department of Neurosurgery, University of Tuebingen Medical Center, Germany
Tomaz Velnar Department of Neurosurgery, University Medical Centre Ljubljana, and AMEU-ECM Maribor, Slovenia
Rainer Ritz Department of Neurosurgery, University of Tuebingen Medical Center, Germany

DOI:

https://doi.org/10.17305/bjbms.2018.3777

Keywords:

intraoperative MRI, mobile MRI, brain tumors, neuronavigation, moveable intraoperative MRI system, iMRI

Abstract

High-field intraoperative MRI (iMRI) systems provide excellent imaging quality and are used for resection control and update of image guidance systems in a number of centers. A ceiling-mounted intraoperative MRI system has several advantages compared to a conventional iMRI system. In this article, we report on first clinical experience with using such a state-of-the-art, the 1.5T iMRI system, in Europe. A total of 50 consecutive patients with intracranial tumors and vascular lesions were operated in the iMRI unit. We analyzed the patients’ data, surgery preparation times, intraoperative scans, surgical time, and radicality of tumor removal.

Patients’ mean age was 46 years (range 8 to 77 years) and the median surgical procedure time was 5 hours (range 1 to 11 hours). The lesions included 6 low-grade gliomas, 8 grade III astrocytomas, 10 glioblastomas, 7 metastases, 7 pituitary adenomas, 2 cavernomas, 2 lymphomas, 1 cortical dysplasia, 3 aneurysms, 1 arterio-venous malformation and 1 extracranial-intracranial bypass, 1 clival chordoma, and 1 Chiari malformation. In the surgical treatment of tumor lesions, intraoperative imaging depicted tumor remnant in 29.7% of the cases, which led to a change in the intraoperative strategy.

The mobile 1.5T iMRI system proved to be safe and allowed an optimal workflow in the iMRI unit. Due to the fact that the MRI scanner is moved into the operating room only for imaging, the working environment is comparable to a regular operating room.