Intelligent operating theater using intraoperative open-MRI.

Malignant brain tumors vary among patients and are characterized by their irregular shapes and infiltration. Localization of functional areas in the brain also differs among patients, and excess removal of tumor near eloquent areas may increase the risk of damage of function, such as motor paresis and speech disturbance. Recent progress in magnetic resonance (MR) imaging technology has enabled acquisition of intraoperative images and totally changed the neurosurgery of malignant brain tumors. Before, surgeons could merely speculate about the results of surgical manipulation and have no certainty about procedure outcomes until postoperative examination. Because intraoperative MR images allow visualization of the size of residual tumor(s) and the positional relationship between the tumor(s) and eloquent areas, surgeons are now able to achieve safe and reliable surgery. As an example, positional error on preoperative MR images caused by shifting of the brain (brain shift), a long-standing annoyance for surgeons, has been resolved using intraoperative MR images for surgical navigation, allowing precise resection. Two types of open-MR imaging scanner, a 0.2- or 0.3-tesla hamburger-type scanner with a horizontal gap and a 0.12- or 0.5-tesla double doughnut-type scanner with a vertical gap, are now available in the operating theater, and 1.5-tesla bore-type scanners are available. A 3.0-tesla bore-type scanner is planned. Intraoperative MR imaging includes diffusion-tensor and diffusion-weighted imaging, which allows visualization of nerve fibers in the white matter, especially the pyramidal tract. Such images are valuable aids in the precise resection of residual lesions of malignant brain tumors near eloquent areas without injuring motor function.

[1]  R. Kikinis,et al.  Development and implementation of intraoperative magnetic resonance imaging and its neurosurgical applications. , 1997, Neurosurgery.

[2]  M M Bonsanto,et al.  Image-guided neurosurgery with intraoperative MRI: update of frameless stereotaxy and radicality control. , 1997, Stereotactic and functional neurosurgery.

[3]  C. Nimsky,et al.  Intraoperative magnetic resonance imaging with the magnetom open scanner: concepts, neurosurgical indications, and procedures: a preliminary report. , 1998, Neurosurgery.

[4]  W. Hall,et al.  Brain tumor resection: intraoperative monitoring with high-field-strength MR imaging-initial results. , 2000, Radiology.

[5]  W. Hall,et al.  Safety, efficacy, and functionality of high-field strength interventional magnetic resonance imaging for neurosurgery. , 2000, Neurosurgery.

[6]  G. Sutherland,et al.  Advances in mobile intraoperative magnetic resonance imaging. , 2000, Neurosurgery.

[7]  M M Bonsanto,et al.  Clinical evaluation and follow-up results for intraoperative magnetic resonance imaging in neurosurgery. , 2000, Neurosurgery.

[8]  C. Nimsky,et al.  Quantification of, Visualization of, and Compensation for Brain Shift Using Intraoperative Magnetic Resonance Imaging , 2000, Neurosurgery.

[9]  Report of Brain Tumor Registry of Japan (1969-1993). , 2000, Neurologia medico-chirurgica.

[10]  H Iseki,et al.  New Possibilities for Stereotaxis , 2001, Stereotactic and Functional Neurosurgery.

[11]  H. Berkenstadt,et al.  Novel, Compact, Intraoperative Magnetic Resonance Imaging-guided System for Conventional Neurosurgical Operating Rooms , 2001, Neurosurgery.

[12]  Kintomo Takakura,et al.  Development of Hitchcock stereotactic frame for intraoperative open MRI , 2002 .

[13]  D. Wikler,et al.  PoleStar N-10 low-field compact intraoperative magnetic resonance imaging system with mobile radiofrequency shielding. , 2003, Neurosurgery.

[14]  Michael Schulder,et al.  Functional Magnetic Resonance Imaging in a Low-Field Intraoperative Scanner , 2004, Stereotactic and Functional Neurosurgery.

[15]  Hiroshi Iseki,et al.  Clinical application of augmented reality in neurosurgical field , 2003, Proceedings Computer Graphics International 2003.

[16]  Christopher Nimsky,et al.  Intraoperative high-field-strength MR imaging: implementation and experience in 200 patients. , 2004, Radiology.

[17]  Christopher Nimsky,et al.  Intraoperative functional MRI: Implementation and preliminary experience , 2005, NeuroImage.

[18]  Christopher Nimsky,et al.  Preoperative and Intraoperative Diffusion Tensor Imaging-based Fiber Tracking in Glioma Surgery , 2005, Neurosurgery.

[19]  H. Iseki,et al.  Accuracy Evaluation of an Update-navigation System for the Resection Surgery of Brain Tumor Using Intraoperative Magnetic Resonance Imaging , 2005 .

[20]  H. Iseki,et al.  Navigation system based on intraoperative diffusion weighted imaging using open MRI , 2005 .

[21]  Ruopeng Wang,et al.  Preoperative and Intraoperative Diffusion Tensor Imaging-based Fiber Tracking in Glioma Surgery , 2005, Neurosurgery.