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
