Institute for Nerve Medicine, Santa Monica, California 90405, USA.
Neurosurgery. 2009 Oct;65(4 Suppl):A212-21. doi: 10.1227/01.NEU.0000346253.89837.6C.
Develop and assess the utility of novel minimal access techniques including percutaneous open-configuration interventional magnetic resonance imaging (iMRI), open surgery using open or closed/cylindrical iMRI systems, and minimal access open surgery with electromyographic guidance in a standard operating room.
For more than 2500 percutaneous open iMRI procedures, 25 incisional surgery open iMRI cases, 3 incisional surgery closed/cylindrical iMRI cases, 25 computed tomography-guided percutaneous procedures, and more than 1000 minimal access incisional surgery cases in the standard operating room with electromyographic guidance, cycle time for intraoperative data collection and numbers of guidance events per case were assessed.
Cycle time varied greatly. The minimum was for open surgery in the standard operating room with direct nerve stimulation for electromyography, requiring 10 to 15 seconds, which was applicable for dozens of assessments during the surgery and had negligible effects on total surgical time. Percutaneous procedures in the open iMRI environment allowed for 20 or 30 imaging events during a procedure, with cycle times of between 10 and 20 seconds. Incisional surgery in the open iMRI system had a cycle time of about 1 to 5 minutes for "in-magnet" procedures and about 5 to 10 minutes for "magnet-adjacent" procedures. Incisional surgery in closed/cylindrical iMRI procedures had a cycle time of 45 to 60 minutes, and the technique proved awkward to use more than once or twice per surgical case.
Percutaneous open-configuration iMRI provides clear benefits over computed tomography or ultrasound. Minimal access surgery and incisional open-configuration iMRI are useful and effective in some situations. Closed/cylindrical iMRI systems pose challenges for patient safety, add greatly to surgical time, and provide limited useful intraoperative benefits.
开发和评估新的微创技术的实用性，包括经皮开放式介入磁共振成像（iMRI）、使用开放式或封闭式/圆柱形 iMRI 系统的开放式手术，以及在标准手术室中使用肌电图引导的微创开放式手术。
在超过 2500 例经皮开放式 iMRI 手术、25 例切口手术开放式 iMRI 病例、3 例切口手术封闭式/圆柱形 iMRI 病例、25 例计算机断层扫描引导的经皮手术以及超过 1000 例在标准手术室中使用肌电图引导的微创切口手术中，评估了术中数据采集的周期时间和每个病例的引导事件数量。
周期时间差异很大。最小的是在标准手术室中直接神经刺激进行肌电图引导的开放式手术，需要 10 到 15 秒，这适用于手术过程中的数十次评估，对总手术时间几乎没有影响。开放式 iMRI 环境下的经皮手术可以在一次手术中进行 20 或 30 次成像事件，周期时间为 10 到 20 秒。开放式 iMRI 系统中的切口手术“在磁体内”手术的周期时间约为 1 到 5 分钟，“磁体附近”手术的周期时间约为 5 到 10 分钟。封闭式/圆柱形 iMRI 手术的周期时间为 45 到 60 分钟，该技术在每个手术病例中使用一次或两次以上时，使用起来很笨拙。
经皮开放式 iMRI 与计算机断层扫描或超声相比具有明显优势。微创手术和开放式微创 iMRI 在某些情况下是有用且有效的。封闭式/圆柱形 iMRI 系统对患者安全构成挑战，大大增加了手术时间，并且提供的术中有用收益有限。
