Development and implementation of intraoperative magnetic resonance imaging and its neurosurgical applications
Development and implementation of intraoperative magnetic resonance imaging and its neurosurgical applications
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DOI：
10.1097/00006123-199710000-00013
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发表时间：
1997-10-01
期刊：
影响因子：
4.8
通讯作者：
Jolesz, FA
中科院分区：
文献类型：
--
作者：
Black, PM;Moriarty, T;Jolesz, FA
目的：我们描述了一种新的开放式磁共振成像（MRI）系统的开发和实施，该系统可以在图像引导下进行神经外科手术。我们最初的神经外科经验包括140例，包括63例立体定向活检，16例囊肿引流，55例开颅手术，3例热消融和3例椎板切除术。介绍了这种新手术方式的手术优势。方法：由通用电气医疗系统与布莱根妇女医院合作开发的0.5 t术中MRI系统（SIGNA SP, Boston， MA）在其磁体内具有垂直间隙，为手术提供物理空间。图像可以在位于该间隙内的监视器上查看，也可以与手术器械的光学跟踪一起获得，从而在器械位置和解剖结构之间建立准确的术中相关性。结果：术中MRI可用于广泛的标准神经外科手术。所获得的图像清晰，并提供准确和即时的信息，用于计划和评估手术进展。结论：术中MRI可以精确定位病变，并可立即评估手术进展。不断更新的图像有助于消除在基于框架和无框架立体定向手术中出现的错误，当解剖结构因脑实质移位或移位而改变其位置时，但与术前获得的图像相关。术中MRI特别有助于确定肿瘤边缘，优化手术入路，实现脑内病变的完全切除，以及监测潜在的术中并发症。
OBJECTIVE: We describe the development and implementation of a new open configuration magnetic resonance imaging (MRI) system, with which neurosurgical procedures can be performed using image guidance. Our initial neurosurgical experience consists of 140 cases, including 63 stereotactic biopsies, 16 cyst drainages, 55 craniotomies, 3 thermal ablations, and 3 laminectomies. The surgical advantages derived from this new modality are presented.METHODS: The 0.5-T intraoperative MRI system (SIGNA SP, Boston, MA), developed by General Electric Medical Systems in collaboration with the Brigham and Women's Hospital, has a vertical gap within its magnet, providing the physical space for surgery. Images are viewed on monitors located within this gap and can also be acquired in conjunction with optical tracking of surgical instruments, establishing accurate intraoperative correlations between instrument position and anatomic structures.RESULTS: A wide range of standard neurosurgical procedures can be performed using intraoperative MRI. The images obtained are clear and provide accurate and immediate information to use in the planning and assessment of the progress of the surgery.CONCLUSION: Intraoperative MRI allows lesions to be precisely localized and targeted, and the progress of a procedure can be immediately evaluated. The constantly updated images help to eliminate errors that can arise during frame-based and frameless stereotactic surgery when anatomic structures alter their position because of shifting or displacement of brain parenchyma but are correlated with images obtained preoperatively. Intraoperative MRI is particularly helpful in determining tumor margins, optimizing surgical approaches, achieving complete resection of intracerebral lesions, and monitoring potential intraoperative complications.