Preliminary experience with an intraoperative MRI-compatible infant headholder: technical note (original) (raw)
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Modified headholder and operating table for intra-operative MRI in neurosurgery
Neurological Research, 1998
In order to facilitate intra-operative use of magnetic resonance imaging (MRI) in neurosurgery an MRIcompatible headholder was developed and adapted to a modified MR-couch simultaneously serving as tabletop for the operating table. To allow shock-free transport into the scanner the wheels of the operating table were replaced by an air cushion mechanism. In 75 procedures the system proved to be reliable and safe. Image quality was not impaired by the fixation device. With growing routine the transfer became straightforward, requiring approximately 10 min. Intra-operative MRI is thus made possible with minimal changes to the standard surgical environment. Its benefit however, still remains to be critically investigated.
High-Field Strength Interventional Magnetic Resonance Imaging for Pediatric Neurosurgery
Pediatric Neurosurgery, 1998
Background: Interventional magnetic resonance (MR) imaging allows neurosurgeons to interactively perform surgery using MR guidance. High-field (1.5-Tesla) strength imaging provides exceptional visualization of intracranial and spinal pathology. The full capabilities of this technology for pediatric neurosurgery have not been defined or determined. Materials and Methods: From January 1997 through June 1998, 10 of 85 cases performed in the interventional MR unit were in the pediatric population (mean age 8.3, median 8, range 2-15 years). Procedures included 2 brain biopsies, 5 craniotomies for tumor, 2 thoracic laminectomies for syringomyelia, and placement of a reservoir into a cystic brainstem tumor. The biopsies and reservoir placement were performed using MR-compatible equipment. Craniotomies and spinal surgery were performed with conventional instrumentation outside the 5-Gauss magnetic footprint. Interactive and intraoperative imaging was performed to assess the goals of surgery. Results: Both brain biopsies were diagnostic for cerebral infarct and anaplastic astrocytoma and the reservoir was optimally placed within the tumor cyst. Of the 5 tumor resections, all were considered radiographically complete. One biopsy patient and 1 tumor resection patient experienced transient neurological deficits after surgery. The patient with the thoracic syrinx required reoperation when the syringosubarachnoid shunt migrated into the syrinx 3 months after initial placement. No patient sustained a postoperative hemorrhage. Tumor histologies found at craniotomy were craniopharyngioma, ganglioglioma, and 3 low-grade gliomas. No evidence of tumor progression has been seen in any of these patients at a mean follow-up of 5.3 (range 4-8) months. The goals of the procedure were achieved in all 10 cases. There were no untoward events experienced related to MRcompatible instrumentation or intraoperative patient monitoring, despite the present inability to monitor core body temperature. Conclusions: 1.5-Tesla interventional MR is a safe and effective technology for assisting neurosurgeons to achieve the goals of pediatric neurosurgery. Preliminary results suggest that surgical resection of histologically benign tumors is enhanced in the interventional MR unit. The incidence of surgically related morbidity is low.
Turkish Neurosurgery, 2012
AIm: Use of intraoperative MRI (iMRI) is the highest contemporary supportive means for brain tumor surgery. In this article we describe the issues related to iMRI use in pediatric cranial operations. mAterIAl and methOds: Pediatric cases operated with the aid of Polestar N20 iMRI system are defined and the pros and cons of the system are emphasized. results: Patient positioning is easier and the obtained images are better in pediatric cases, particularly for posterior fossa tumors. COnClusIOn: iMRI should be used in all pediatric brain tumor operations when possible.
Versatile intraoperative MRI in neurosurgery and radiology
Acta neurochirurgica, 2002
Several models for the application of intra-operative magnetic resonance imaging (IMRI) have recently been reported, most of them unique. Two fundamental issues need to be addressed: optimal use of the scanner to ensure a wide base for research, development and clinical application, and an organisational model that facilitates such use. While in our setting the IMRI project was initiated by the neurosurgeons, the need for wider use of the facilities was recognised since the beginning of the planning phase in 1996. An organisational model was developed that allowed for development of neurosurgical applications, radiological imaging, and radiological interventions and for the research and development work of the vendor. A resistive 0.23 T MR scanner was installed in a dedicated operating room environment. Unique to this scanner is the ability to turn off the magnet, allowing for normal OR activities and devices, and to turn on the magnet as needed with a relatively short six-minute ra...
Child's Nervous System, 2012
Introduction We analyze our preliminary experience using the PoleStar N20 mobile intraoperative MR (iMR) system as an adjunct for pediatric brain tumor resection. Methods We analyzed 11 resections in nine children between 1 month and 17 years old. After resection, we acquired iMR scans to detect residual tumor and update neuronavigation. We compared final iMR interpretation by the neurosurgeon with early postoperative MR interpretation by a neuroradiologist. Results Patient positioning was straightforward, and image quality (T1 7-min 4-mm sequences) sufficient in all cases. In five cases, contrast enhancement suspect for residual tumor was noted on initial postresection iMR images. In one case, a slight discrepancy with postoperative imaging after 3 months was no longer visible after 1 year. No serious perioperative adverse events related to the PoleStar N20 were encountered, except for transient shoulder pain in two.
Neurosurgery, 2001
OBJECTIVE Preliminary clinical experience with a novel, compact, intraoperative magnetic resonance imaging (MRI)-guided system that can be used in an ordinary operating room is presented. DESCRIPTION OF INSTRUMENTATION The system features an MRI scanner integrated with an optical and MRI tracking system. Scanning and navigation, which are operated by the surgeon, are controlled by an in-room computer workstation with a liquid crystal display screen. The scanner includes a 0.12-T permanent magnet with a 25-cm vertical gap, accommodating the patient's head. The field of view is 11 × 16 cm, encompassing the surgical area of interest. The magnet is mounted on a transportable gantry that can be positioned under the surgical table when not in use for scanning, thus rendering the surgical environment unmodified and allowing the use of standard instruments. The features of the integrated navigation system allow flap planning and intraoperative tracking based on updated images acquired d...
Does the Use of an Immobilizer Provide a Quality MR Image of the Brain in Infants?
Journal of Radiology Nursing, 2012
Magnetic resonance imaging (MRI) provides key clinical and diagnostic information for care of neonates and young infants. However, to obtain quality images, they need to be motionless in the scanner, often with the aid of sedation medications, which put them at risk for complications. An immobilizer device (an airtight, chambered device that safely and securely fastens around the infant without applying pressure) allows the infant to feel snug and warm, sleepy and motionless, and can be used as an alternative to sedation for this population. We conducted a retrospective, descriptive, comparative study at The Children's Hospital of Philadelphia MRI Department in the Division of Radiology. Inclusion criteria were infants less than or equal to 90 days of age, weighing at least 2 kg, requiring a MRI brain scan that is predicted to take no more than 60 min to complete. We obtained data on 36 patients who received sedation medications for their brain MRI scan, and 36 patients who completed their brain MRI scan without the use of sedation medication, but rather were in the "feed and immobilize" group. Results of the study showed that brain MRIs on sedated infants took longer, and those infants were more likely to experience oxygen desaturation and require supplemental oxygen post-MRI. Most importantly, we found that the MR images were considered diagnostic in 100% of the sedated infants and 94% of the immobilized infants, although significantly more immobilized infants had artifact from motion than sedated infants. Implications for practice include potential cost saving and increased patient's safety (e.g., more stable respiratory status). (J Radiol Nurs 2012;31:91-96.)
Intracranial surgery with a compact, low-field-strength magnetic resonance imager
Topics in magnetic resonance imaging : TMRI, 2009
Intraoperative magnetic resonance imaging (iMRI) has been a reality for more than a decade. As technology has begun to mature, the focus on practicality and user-friendliness has sharpened. In addition, the need for well-designed and well-executed outcome studies remains so that expensive new instruments such as iMRI can be justified. We present our experience with the PoleStar system, a compact, low-field-strength iMRI designed to make intraoperative imaging a routine component of intracranial neurosurgery. The advantages and limitations of this approach are discussed in the context of different clinical applications.