Use of intraoperative MRI adds time but care-changing information to neurosurgery, study shows

Although the use of intraoperative MRI can add time to surgical procedures, it can help surgeons detect residual disease and, if needed, modify their plan for surgery while the patient is on the operating room table, according to a study conducted by researchers at the University Hospitals of Cleveland/Case Western Reserve University in Cleveland, OH and Johns Hopkins University in Baltimore, MD.

The study included 122 patients between the ages of 6-77 who underwent 130 neurosurgical and ear, nose and throat procedures, including 106 craniotomies and 17 pituitary resections. The study showed that 73% of the patients who had undergone intraoperative MRI had additional surgical resection based on the intraoperative findings, said Jonathan Lewin, MD, lead author of the study. Each patient had between one and five intra-or postoperative imaging sessions which were between 1.7 seconds to 8 minutes. According to the study, the added total imaging time per case was around 35 minutes.

“While neurosurgeons and neuroradiologists have been enthusiastic about the potential of intraoperative MRI, no one had investigated the additional time required to add this to a routine neurosurgical case,” Dr. Lewin said. “With the development of several technological advances geared toward limiting the time required, our goal was to quantitatively measure the impact on surgery from both the time perspective and the benefit of this additional information,” he said.

“With appropriate technology and workflow design, the benefits of real-time MRI information during surgical procedures can be provided without significant prolongation of the cases,” said Dr. Lewin.The neurosurgical physicians have readily adopted the use of intraoperative MRI despite the additional time required, he said.

The full results of this study appear in the November issue of the American Journal of Roentgenology, published by the American Roentgen Ray Society.