Minimally Invasive Neurosurgery within a 0.5 Tesla Intraoperative Magnetic Resonance Scanner Using an Off-Line Neuronavigation System

Abstract

Background and Purpose: We evaluated an advanced concept for patient-based navigation during minimally invasive neurosurgical procedures. Methods: An infrared-based, off-line neuronavigation system (LOCALITE, Bonn, Germany) was applied during operations within a 0.5 T intraoperative MRI scanner (iMRI) (Signa SF, GE Medical Systems, Milwaukee, WI, USA) in addition to the conventional real-time system. The three-dimensional (3D) data set was acquired intraoperatively and up-dated when brain-shift was suspected. Twenty-three patients with subcortical lesions were operated upon with the aim to minimise the operative trauma. Results: Small craniotomies (median diameter 30 mm, mean diameter 27 mm) could be placed exactly. In all cases, the primary goal of the operation (total resection or biopsy) was achieved in a straightforward procedure without permanent morbidity. The navigation system could be easily used without technical problems. In contrast to the real-time navigation mode of the MR system, the higher quality as well as the real-time display of the MR images reconstructed from the 3D reference data provided sufficient visual-manual coordination. Conclusion: The system combines the advantages of conventional neuronavigation with the ability to adapt intraoperatively to the continuously changing anatomy. Thus, small and/or deep lesions can be operated upon in straightforward minimally invasive operations.

Brain tumour surgery - intraoperative MRI - minimally invasive neurosurgery - neuronavigation

References

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