Intelligent operating theater using intraoperative open-MRI.
Intelligent operating theater using intraoperative open-MRI.
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DOI：
10.2463/mrms.4.129
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发表时间：
2005-01-01
期刊：
影响因子：
--
通讯作者：
Takakura, Kintomo
中科院分区：
文献类型：
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作者：
Iseki, Hiroshi;Muragaki, Yoshihiro;Takakura, Kintomo
恶性脑肿瘤因患者而异，其特征在于其不规则形状和浸润。脑内功能区的定位也因患者而异，功能区附近的肿瘤过度切除可能会增加功能受损的风险，如运动麻痹和言语障碍。磁共振成像技术的最新进展使术中图像的获取成为可能，并彻底改变了恶性脑肿瘤的神经外科治疗。以前，外科医生只能推测手术操作的结果，直到术后检查才能确定手术结果。由于术中MR图像可以显示残留肿瘤的大小以及肿瘤与功能区之间的位置关系，因此外科医生现在能够实现安全可靠的手术。例如，由于大脑移位（大脑移位）引起的术前MR图像上的位置误差，这是外科医生长期以来的烦恼，已经通过使用术中MR图像进行手术导航来解决，从而实现精确切除。两种类型的开放式MR成像扫描仪，一种是具有水平间隙的0.2或0.3特斯拉汉堡型扫描仪，一种是具有垂直间隙的0.12或0.5特斯拉双甜甜圈型扫描仪，目前可在手术室使用，还有1.5特斯拉孔型扫描仪。一个3.0特斯拉的钻孔式扫描仪正在计划中。术中磁共振成像包括弥散张量成像和弥散加权成像，可显示白色物质中的神经纤维，尤其是锥体束。这些影像有助于精确切除功能区附近的恶性脑肿瘤残留病灶，而不损伤运动功能。
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.