Intraoperative MRI

Intraoperative MRI demonstrates whether tumor is excised or not. Physiological centers are not damaged and variable details are obtained about the tumor during the surgery

Concomitant use of all intraoperative technological systems is of vital importance for a successful neurosurgical procedure. Concomitant use of intraoperative MRI, navigation, ultrasound and Gamma Knife methods at neurosurgery operating theater ensures all imaging modalities are rapidly and completely used before, during and after the surgery.

Neuronavigation implies use of preoperative images during surgery in this system. Navigation system enables surgeons use anatomic or physiological images intraoperatively (such as localization of motor center for speech), which are obtained from MRI scans. This method involves transferring preoperative MRI scans of the patient to the navigation device. Thus, surgeon can make surgical plans by visualizing cerebral localizations, which pose risk, thanks to intra-operative use of real-time navigation.

Intraoperative MRI

Tumor can be accessed under guidance of real-time navigation; however, this system alone is not sufficient. After excision of tumor is started, it may be required to repeat MRI scan during surgery at a particular phase. Intraoperative MRI enables obtaining MRI scans during surgery.

Minor displacement may occur at the localization of the tumor, since cerebrospinal fluid drains during the surgery. More than MRI can be intraoperatively scanned to determine the displacement. Error rate is almost zero and the tumor is almost completely excised with minimal risk.

Intraoperative MRI demonstrates whether tumor is excised or not. Physiological centers are not damaged and variable details are obtained about the tumor during the surgery.

Three-Dimensional Ultrasound

Intraoperative ultrasound is another imaging modality – technological advancement, which guides neurosurgical procedures. Preoperative MRI or angiography images are combined with ultrasonographic images, which are obtained while tumor is excised. Intraoperative real-time ultrasonographic details enable surgeons decide the extent the tumor is excised. New-generation ultrasound devices produce three-dimensional images of the tumor during surgery, resulting with a significant advantage.

Integrated With Gamma Knife

Gamma Knife radiosurgery is, undoubtedly, a revolutionary method for the Neurosurgery discipline. Here, the point is the concomitant use of Gamma Knife and other technological methods. In other words, Gamma Knife imaging-guided neurosurgery should be integrated to the system of operating theater and it should be used in coordination with other systems.

For instance, cerebral tumor of the patient might have invaded “motor center for speech” in the brain. Neurosurgeons may prefer partial resection of the tumor in order to avoid damaging the motor center for speech. In this case, patient is recovered from anesthesia and Gamma Knife therapy can be applied without removing stereotactic frame. Thus, motor center for speech is not damaged, while a substantial part of tumor is excised and Gamma Knife is started and completed for rest tumor, before patient is transferred to the room.

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Date:
10 January, 2015
Skills:
Medical Park Göztepe Hospital - İstanbul
Author:
Prof. Dr. Türker Kılıç

Intraoperative MRI demonstrates whether tumor is excised or not. Physiological centers are not damaged and variable details are obtained about the tumor during the surgery