Kremer Paul, Tronnier V, Steiner H H, Metzner R, Ebinger F, Rating D, Hartmann M, Seitz A, Unterberg A, Wirtz C R
Neurosurgical Department, University of Heidelberg, Heidelberg, Germany.
Childs Nerv Syst. 2006 Jul;22(7):674-8. doi: 10.1007/s00381-005-0030-2. Epub 2006 Feb 1.
Despite the introduction of neuronavigational systems, radical tumor removal is still problematic in many neurosurgical procedures. Thus, direct intraoperative imaging for tumor resection control was implemented with an intraoperative magnetic resonance imaging (ioMRI) scanner installed in the operating room. Whereas most procedures with ioMRI were carried out in adults, we summarize 7 years of experience using ioMRI in children for interventional neurosurgical procedures or for tumor resection control.
An open magnetic resonance scanner (Magnetom Open 0.2 T) was installed in the neurosurgical operating room. For tumor resection control, ioMRI was performed in 35 procedures. After the ioMRI scans were analyzed with respect to quality, the identification of residual tumor was considered by the attending neuroradiologist and neurosurgeon. If residual tumor tissue was present, a new three-dimensional (3D) dataset was acquired to update the neuronavigation; subsequently, the tumor resection was extended. In all these procedures, the results of the ioMRI were checked by an early postoperative high-field magnetic resonance imaging (MRI) study. In addition, ioMRI was carried out in ten other children to monitor interventional neurosurgical procedures.
In all children, ioMRI was adequate both for tumor resection control and monitoring of interventional procedures. Primary radical removal of tumor was reached in 40% as confirmed by ioMRI, but in 60% of the patients, the tumor resection procedure was extended after residual tumor was detected using the new 3D dataset for navigational update. By using ioMRI, radical tumor removal improved up to 83% as confirmed by early postoperative MRI. Procedure-related complications were not seen in our series. For all MR-guided biopsies, histology findings could be confirmed, and aspiration of intracranial cysts or abscesses could be monitored online.
IoMRI using the open magnetom is suitable for detecting residual tumor tissue, can compensate for the phenomenon of brain shift using a new intraopertive 3D dataset for extended tumor resection, and is capable of monitoring interventional neurosurgical procedures. By using ioMRI for tumor resection control, the degree of tumor resection could be significantly improved.
尽管引入了神经导航系统，但在许多神经外科手术中，彻底切除肿瘤仍然存在问题。因此，通过安装在手术室的术中磁共振成像（ioMRI）扫描仪实现了用于肿瘤切除控制的直接术中成像。虽然大多数使用ioMRI的手术是在成人中进行的，但我们总结了7年来在儿童中使用ioMRI进行介入性神经外科手术或肿瘤切除控制的经验。
在神经外科手术室安装了一台开放式磁共振扫描仪（Magnetom Open 0.2 T）。为了控制肿瘤切除，在35例手术中进行了ioMRI检查。在对ioMRI扫描的质量进行分析后，由主治神经放射科医生和神经外科医生考虑识别残留肿瘤。如果存在残留肿瘤组织，则获取新的三维（3D）数据集以更新神经导航；随后，扩大肿瘤切除范围。在所有这些手术中，通过术后早期高场磁共振成像（MRI）研究检查ioMRI的结果。此外，对其他10名儿童进行了ioMRI检查，以监测介入性神经外科手术。
在所有儿童中，ioMRI对于肿瘤切除控制和介入手术监测均足够。经ioMRI证实，40%的患者实现了肿瘤的初次根治性切除，但在60%的患者中，使用新的3D数据集进行导航更新检测到残留肿瘤后，扩大了肿瘤切除手术范围。通过使用ioMRI，术后早期MRI证实肿瘤的根治性切除率提高至83%。我们的系列研究中未发现与手术相关的并发症。对于所有MR引导的活检，组织学结果均可得到证实，并且可以在线监测颅内囊肿或脓肿的抽吸情况。
使用开放式磁体的ioMRI适用于检测残留肿瘤组织，能够使用新的术中3D数据集补偿脑移位现象以扩大肿瘤切除范围，并且能够监测介入性神经外科手术。通过使用ioMRI进行肿瘤切除控制，可以显著提高肿瘤切除程度。
