Bernstein M, Al-Anazi A R, Kucharczyk W, Manninen P, Bronskill M, Henkelman M
Division of Neurosurgery, Toronto Western Hospital, University Health Network, Ontario, Canada.
Neurosurgery. 2000 Apr;46(4):900-7; discussion 907-9. doi: 10.1097/00006123-200004000-00023.
Frameless navigation systems represent a huge step forward in the surgical treatment of intracranial pathological conditions but lack the ability to provide real-time imaging feedback for assessment of postoperative results, such as catheter positions and the extent of tumor resections. An open magnetic resonance imaging system for intracranial surgery was developed in Toronto, by a multidisciplinary team, to provide real-time intraoperative imaging.
The preliminary experience with a 0.2-T, vertical-gap, magnetic resonance imaging system for intraoperative imaging, which was developed at the University of Toronto for the surgical treatment of patients with intracranial lesions, is described. The system is known as the image-guided minimally invasive therapy unit.
Between February 1998 and March 1999, 36 procedures were performed, including 21 tumor resections, 12 biopsies, 1 transsphenoidal endoscopic resection, and 2 catheter placements for Ommaya reservoirs. Three complications were observed. All biopsies were successful, and the surgical goals were achieved for all resections. Problems included restricted access resulting from the confines of the magnet and the imaging coil design, difficulties in working in an operating room that is less spacious and familiar, inconsistent image quality, and a lack of nonmagnetic tools that are as effective as standard neurosurgical tools. Advantages included real-time imaging to facilitate surgical planning, to confirm entry into lesions, and to assess the extent of resection and intraoperative and immediate postoperative imaging to confirm the extent of resections, catheter placement, and the absence of postoperative complications.
Intraoperative magnetic resonance imaging has great potential as an aid for intracranial surgery, but a number of logistic problems require resolution.
无框架导航系统在颅内疾病的外科治疗方面向前迈出了巨大一步，但缺乏为评估术后结果（如导管位置和肿瘤切除范围）提供实时成像反馈的能力。多伦多的一个多学科团队开发了一种用于颅内手术的开放式磁共振成像系统，以提供实时术中成像。
描述了在多伦多大学开发的用于术中成像的0.2-T垂直间隙磁共振成像系统的初步经验，该系统用于颅内病变患者的外科治疗。该系统被称为图像引导微创治疗单元。
在1998年2月至1999年3月期间，共进行了36例手术，包括21例肿瘤切除术、12例活检、1例经蝶窦内镜切除术和2例用于奥马亚储液器的导管置入术。观察到3例并发症。所有活检均成功，所有切除术均实现了手术目标。问题包括由于磁体和成像线圈设计的限制导致的操作空间受限、在空间较小且不熟悉的手术室工作困难、图像质量不一致以及缺乏与标准神经外科工具一样有效的非磁性工具。优点包括实时成像便于手术规划、确认进入病变部位以及评估切除范围，以及术中及术后即刻成像以确认切除范围、导管置入位置和无术后并发症。
术中磁共振成像作为颅内手术的辅助手段具有巨大潜力，但一些后勤问题需要解决。
