Department of Neurosurgery, University of Duisburg-Essen, Hufelandstr. 55, 45122 Essen, Germany.
Acta Neurochir (Wien). 2010 Jun;152(6):947-51. doi: 10.1007/s00701-010-0607-8. Epub 2010 Feb 19.
Intraoperative MRI (iMRI) has been established as a routine imaging modality with a remarkable impact on specific neurosurgical procedures. The technological advancement continuously extends the spectrum of iMRI, leading to an increasing number of installations. Yet, procedures in which a semi-sitting position would be advantageous were beyond the reach of iMRI.
We performed an iMRI-guided surgical procedure in a patient with a cystic lesion of the inferior parieto-occipital lobe while the patient was placed in a semi-sitting position, employing a mobile 0.15-T intraoperative MRI system. For that purpose, we adapted a standard OR table according to the needs of iMRI.
Patient positioning could be accomplished easily. For intraoperative scanning, the OR table was tilted backwards so as to position the patient's head in the magnet's aperture. Obtained images were used for neuronavigated cyst evacuation via burr hole trephination after repositioning the OR table. Subsequent intraoperative imaging documented collapse of the cyst at the end of the procedure. There were no adverse effects resulting from the combination of semi-sitting position and iMRI guidance.
This report demonstrates for the first time that the combination of iMRI and the semi-sitting position is feasible and that this procedure bears specific benefits. Issues such as brain shift due to table tilting warrant further investigations in order to expand this technique to posterior fossa craniotomies.
术中磁共振成像（iMRI）已成为一种常规的成像方式，对特定的神经外科手术有显著影响。技术的进步不断扩展了 iMRI 的应用范围，导致越来越多的安装。然而，在半坐位置下进行手术的情况超出了 iMRI 的能力范围。
我们在一名患者中进行了 iMRI 引导的手术，该患者患有下顶枕叶的囊性病变，患者处于半坐位置，使用移动的 0.15-T 术中磁共振成像系统。为此，我们根据 iMRI 的需求对标准手术台进行了改造。
患者的定位可以轻松完成。为了进行术中扫描，手术台向后倾斜，以使患者的头部位于磁体孔径内。获得的图像用于通过颅骨钻孔在重新定位手术台后进行神经导航下的囊液排空。随后的术中成像记录了手术结束时囊肿的塌陷。半坐位置和 iMRI 引导的结合没有产生任何不良反应。
本报告首次证明了 iMRI 和半坐位置的结合是可行的，并且该手术具有特定的优势。由于手术台倾斜引起的脑移位等问题需要进一步研究，以便将该技术扩展到后颅窝开颅术。
