Intraoperative Magnetic Resonance Imaging: Impact on Brain Tumor Surgery

BACKGROUND: Refinements in the imaging of intracranial tumors assist neurosurgeons in maximizing resections in a safe manner. Intraoperative magnetic resonance imaging (iMRI) represents a recent addition to their therapeutic armamentaria. METHODS: The authors reviewed the development of iMRI and describe their experience with iMRI-guided resection of intracranial tumors in 112 patients. The PoleStar N-10 iMRI system was used in this series. RESULTS: Intraoperative imaging resulted in additional tumor removal in 40 (36%) of the patients. In another 35 (31%), imaging confirmed that the goals of surgery had been attained so potentially harmful dissection in and around the brain was avoided. For patients with lesions of the skull base, iMRI was possible in all but 2 patients who had a large body habitus. There was a decrease in length of hospital stay for patients who had surgery with iMRI. Lesion location did not play a role in this change. Brain tumor surgery was affected in 67% of patients. A potential for cost savings with iMRI was demonstrated. CONCLUSIONS: Intraoperative imaging with MRI is the latest evolution in the increasing precision of neurosurgery. The advantages of this technology will make it a ubiquitous feature in the neurosurgical operating room.