Cranial surgery navigation aided by a compact intraoperative magnetic resonance imager

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Object. In this article the authors report on a novel, compact device for magnetic resonance (MR) imaging that has been developed for use in a standard neurosurgical operating room.

Methods. The device includes a permanent magnet with a field strength of 0.12 tesla. The poles of the magnet are vertically aligned, with a gap of 25 cm. When not in use the magnet is stored in a shielded cage in a corner of the operating room; it is easily moved into position and attaches to a regular operating table. The magnet is raised for imaging when needed and may be lowered to allow surgery to proceed unencumbered. Surgical navigation with optical and/or magnetic probes is incorporated into the system.

Twenty-five patients have undergone removal of intracranial lesions with the aid of this device. Operations included craniotomy for tumor or other lesion in 18 patients and transsphenoidal resection of tumor in seven. The number of scans ranged from two to five per surgery (average 3.4); image quality was excellent in 45%, adequate in 43%, and poor in 12%. In four patients MR imaging revealed additional tumor that was then resected; in five others visual examination of the operative field was inconclusive but complete tumor removal was confirmed on MR imaging. In 21 patients early postoperative diagnostic MR studies corroborated the findings on the final intraoperative MR image.

Using a water-covered phantom, the accuracy of the navigational tools was assessed; 120 data points were measured. The accuracy of the magnetic probe averaged 1.3 mm and 2.1 mm in the coronal and axial planes, respectively; the optical probe accuracy was 2.1 mm and 1.8 mm in those planes.

Conclusions. This device provides high-quality intraoperative imaging and accurate surgical navigation with minimal disruption in a standard neurosurgical operating room.

Article Information

Address reprint requests to: Michael Schulder, M.D., Department of Neurosurgery, New Jersey Medical School, 90 Bergen Street, Suite 7300, Newark, New Jersey 07103. email: schulder@umdnj.edu.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    Photograph showing the PoleStar N-10 docked to a regular operating room table. The viewing monitor is to the right. Single asterisk designates the cabinet for magnet storage; double asterisk designates the infrared cameras for optical navigation.

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    Photograph showing patient positioned for surgery in the dedicated head-holder device.

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    Photograph showing repeated registration being performed during surgery. The magnet is also in position to acquire a new image.

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    Upper Left: Preoperative diagnostic MR image. Upper Right: Postoperative diagnostic MR image with no enhancement seen after contrast administration. Lower: Serial MR images in which the compare function was used, with slices at identical levels. The images are ordered from left to right, with the time of acquisition in the upper right corner of each image. On the bottom row of images, the target (T) is placed over an area of pooled gadolinium. Comparison with earlier images confirms that this does not correspond with tumor enhancement.

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    Left: Axial T1-weighted diagnostic MR image with contrast. Right: Postoperative diagnostic MR image confirming complete tumor resection.

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    Left: Preliminary coronal intraoperative MR images; despite some magnetic artifact on the left side of the image, the fourth ventricle and tumor are clearly seen. Right: Intraoperative MR images obtained after resection; arrows point to residual tumor.

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    Upper Two Rows: Intraoperative MR images obtained after patient positioning; a radiofrequency artifact is present but does not interfere with visualization of the tumor. Lower Two Rows: Images obtained after resection confirming the absence of residual tumor.

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