Intraoperative MRI without an intraoperative MRI suite: a workflow for glial tumor surgery

• Published in: Acta neurochirurgica Vol. 166; no. 1; p. 292
• Main Authors: Frisk, Henrik, Persson, Oscar, Fagerlund, Michael, Jensdottir, Margret, El-Hajj, Victor Gabriel, Burström, Gustav, Sunesson, Annika, Kits, Annika, Majing, Tomas, Edström, Erik, Kaijser, Magnus, Elmi-Terander, Adrian
• Format: Journal Article
• Language: English
• Published: Vienna Springer Vienna 2024; Springer Nature B.V
• Subjects: Adult; Adverse events; Aged; Anesthesia; Brain Neoplasms - diagnostic imaging; Brain Neoplasms - surgery; Brain tumors; Complications; Feasibility Studies; Female; Glioma; Glioma - diagnostic imaging; Glioma - surgery; Humans; Interventional Radiology; Intraoperative MRI; Magnetic resonance imaging; Magnetic Resonance Imaging - methods; Male; Medicin och hälsovetenskap; Medicine; Medicine & Public Health; Middle Aged; Minimally Invasive Surgery; Monitoring, Intraoperative - methods; Neurology; Neuroradiology; Neurosurgery; Neurosurgical Procedures - methods; Neurosurgical technique evaluation; Operating Rooms; Original; Original Article; Postoperative; Radiology; Surgery; Surgical Orthopedics; Workflow; Wound healing; Wound infection; Intraoperative MRI; Workflow; Glioma surgery
• ISSN: 0942-0940; 0001-6268; 0942-0940
• DOI: 10.1007/s00701-024-06165-0

Background Intraoperative MRI (iMRI) has emerged as a useful tool in glioma surgery to safely improve the extent of resection. However, iMRI requires a dedicated operating room (OR) with an integrated MRI scanner solely for this purpose. Due to physical or economical restraints, this may not be feasible in all centers. The aim of this study was to investigate the feasibility of using a non-dedicated MRI scanner at the radiology department for iMRI and to describe the workflow with special focus on time expenditure and surgical implications. Methods In total, 24 patients undergoing glioma surgery were included. When the resection was deemed completed, the wound was temporarily closed, and the patient, under general anesthesia, was transferred to the radiology department for iMRI, which was performed using a dedicated protocol on 1.5 or 3 T scanners. After performing iMRI the patient was returned to the OR for additional tumor resection or final wound closure. All procedural times, timestamps, and adverse events were recorded. Result The median time from the decision to initiate iMRI until reopening of the wound after scanning was 68 (52–104) minutes. Residual tumors were found on iMRI in 13 patients (54%). There were no adverse events during the surgeries, transfers, transportations, or iMRI-examinations. There were no wound-related complications or infections in the postoperative period or at follow-up. There were no readmissions within 30 or 90 days due to any complication. Conclusion Performing intraoperative MRI using an MRI located outside the OR department was feasible and safe with no adverse events. It did not require more time than previously reported data for dedicated iMRI scanners. This could be a viable alternative in centers without access to a dedicated iMRI suite.