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Clinical Research
Available online 6 October 2021
Intraoperative high-field resonance: How to optimize its use in our healthcare system
Resonancia intraoperatoria de alto campo: cómo optimizar su uso en nuestro modelo sanitario
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Hiria Limpo
Corresponding author
hiria.limpo@gmail.com

Corresponding author.
, Ricardo Díez, Julio Albisua, Sonia Tejada
Departamento de Neurocirugía, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
Received 08 December 2020. Accepted 18 May 2021
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Abstract
Background and aims

Intraoperative MRI (ioMRI) consists of performing a MRI during brain or spinal surgery. Although it is a safe and useful technique, it is available in a few hospitals. This means some aspects are not perfectly defined or standardized, forcing each center to develop its own solutions. Our goal is to describe the technique, evaluate the changes made to optimize its use and thus be able to facilitate the intraoperative resonance implementation in other neurosurgery departments.

Methods

A prospective analysis of patients consecutively operated using high-field ioMRI guidance was carried out, describing the type of tumor, clinical data, time and sequences of ioMR, use of intraoperative neurophysiology, preoperative tumor volume, after ioMR, and postoperative, as well as complications.

Results

ioMR was performed in 38 patients selected from among 425 brain tumors (9%) operated on in this interval. The tumor types were: 11 glioblastomas, 8 anaplastic astrocytomas, 5 diffuse astrocytomas, 4 meningiomas, 3 oligodendrogliomas, 2 metastases, 2 epidermoid cysts, 1 astroblastoma, 1 arachnoid cyst and 1 pituitary adenoma.

The mean age was 45 years. The mean preoperative tumor volume was 45.22cc, after the ioMR 5.08cc and postoperative 1.28cc.

Resection was extended after ioMR in 76%. Gross total resection was achieved in 15 patients and residual tumor of less than 1cc was observed in 8. An intentional tumor tissue was left in an eloquent brain region (mean volume 7cc) in 13 patients.

Bleeding and ischemia complications were detected early on ioMR in 5%.

MRI length was 47 min on average.

Conclusions

Intraoperative MRI was a useful and safe technique, and no associated complications were registered.

Keywords:
Intraoperative magnetic resonance
Brain tumors resection
Intraoperative imaging in neurosurgery
Innovation in neurosurgery
Resumen
Antecedentes y objetivo

La RM intraoperatoria (RMio) consiste en la realización de una resonancia durante la cirugía de una lesión cerebral o espinal. Es una técnica segura y útil, aunque está disponible en pocos hospitales y algunos aspectos no están perfectamente definidos ni estandarizados, por lo que cada centro elabora sus propias soluciones. Nuestro objetivo es describir la técnica utilizada para la realización de RMio, evaluar los cambios que se han ido realizando para optimizar su uso desde el comienzo y así poder facilitar la puesta en marcha de una resonancia intraooperatoria en otros departamentos de neurocirugía.

Material y métodos

Estudio prospectivo de pacientes intervenidos consecutivamente con RMio, describiendo el tipo de tumor, datos clínicos, tiempo y secuencias de RMio, empleo de neurofisiología intraoperatoria, volumen tumoral preoperatorio, tras la RMio, y postoperatorio, y complicaciones observadas.

Resultados

Se realizó RMio en 38 pacientes seleccionados de los 425 tumores cerebrales (9%) operados en este intervalo. Los tipos tumorales fueron: 11 glioblastomas, 8 astrocitomas anaplásicos, 5 astrocitomas difusos, 4 meningiomas, 3 oligodendrogliomas, 2 metástasis, 2 quistes epidermoides, 1 astroblastoma, 1 quiste aracnoideo y 1 adenoma hipofisario.

La edad media fue 45 años. El volumen tumoral preoperatorio medio fue 45,22cc, tras la RMio de 5,08 cc y el postoperatorio 1,28 cc.

En el 76% se amplió la resección tras la RMio. En 15 pacientes se consiguió una resección completa y en 8 se objetivó un resto menor de 1cc. En 13 pacientes se dejó un resto intencional en área elocuente o regiones de base de cráneo (volumen medio 7cc).

En un 5% se detectaron complicaciones de sangrado e isquemia de forma precoz en la RMio.

La realización de la RMio requirió una media de 47 minutos.

Conclusiones

La RMio resultó una técnica útil y segura sin registrarse complicaciones relacionadas con su realización.

Palabras clave:
Resonancia magnética intraoperatoria
Resección de tumores cerebrales
Imagen intraoperatoria en neurocirugía
Innovacón en neurocirugía

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