ABSTRACT
The 0.5-T intraoperative magnetic resonance imaging (MRI) (General Electric) allows a surgeon to operate under direct MR guidance. We present the first application to neurovascular surgery through a series of 11 patients with vascular lesions, including 2 arteriovenous malformations (AVM), 8 cavernous malformations, and a pineal region cyst in which drainage required navigation through the venous structures in this area. Operating in this system provided accurate localization of each lesion, which in turn allowed the size of the craniotomy and the dural opening to be minimized. The optimal trajectory of approach was chosen and executed under real-time image guidance. Intraoperative MRA in the AVM and pineal cyst cases further defined the vascular anatomy. Confirmation of complete resection was obtained through imaging prior to closing. The intraoperative MRI provides a minimally invasive approach for neurovascular surgery. Advantages include real-time localization of vascular lesions, increased safety of approach through the choice of the optimal trajectory, definitive intraoperative identification of vascular structures and their relationship to surgical anatomy, verification of complete resection, and monitoring of intraoperative hemorrhage.
KEYWORD
Intraoperative MRI - image guidance - neurovascular surgery
