MRI Improves Tumor Removal During Brain Surgery

A custom-designed magnetic resonance imaging (MRI) scanner can help neurosurgeons remove brain tumors and all of the residual cancer during one surgical procedure.

A study published in the October 2004 issue of the journal Radiology described how by utilizing intra-operative MR-guidance, surgical approach was altered in one out of four instances. "Imaging during surgery provides intra-operative quality control. It presents valuable information during the procedure that allows the surgeon an opportunity to adjust the strategy,” stated lead author Christopher Nimsky, M.D., an associate professor of the University Erlangen-Nuremberg, Germany (www.uni-erlangen.de). Before intra-operative imaging, small pieces of the tumor can be unintentionally overlooked. This tumor residue typically needs repeated surgical intervention, surveillance, or additional treatment.

In the study, the investigators used intra-operative high-field MRI in 200 patients. They assessed the extent of tumor removal seen by intra-operative MRI and how the surgical approach was changed. They discovered that imaging quality was indistinguishable between pre- and intra-operative scans. In 27.5% of patients, intra-operative MRI influenced surgical strategy, usually depicting additional tissue that needed to be excised.

MR is the imaging technique of choice for pre-operative diagnosis of brain tumors and epilepsy. Scientists are now utilizing its high-field scanning abilities for intra-operative procedures because its produces better image quality with less scan time. However, high-field MRI is still a costly imaging technique and will continue to be for at least the next couple of years. Dr. Nimsky hopes that in the near future, flat MRI scanners might be positioned underneath operating tables to further optimize the intra-operative application of MRI technology. He said that the best solution is a nearly invisible imaging system that provides real-time feedback to the neurosurgeon without disrupting the surgical workflow.




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