Intraoperative MRI increases accuracy, decreases risks
issue 19 | Fall 2013
Intraoperative MRI technology that provides real-time patient assessment during surgery is now available for both adult and pediatric patients at the University of Michigan. U-M is the only hospital in Michigan bringing intraoperative MRI (iMRI) technology to the patient on the operating table. This allows for the surgical field to remain intact and avoids the need to move or reposition the patient, which increases accuracy and lowers the risk of injury.
"iMRI technology is particularly advantageous in brain and spinal cord tumor resections, as this technology can show the exact interface between healthy neurological tissue and a tumor during the surgery," explains Hugh Garton, M.D., pediatric neurosurgeon at U-M's C.S. Mott Children's Hospital. "This can decrease the necessity of performing a partial resection or intentionally leaving tumor tissue behind in efforts to protect vital neurologic structure adjacent to the tumor."
iMRI uses standard MRI infrastructure that is deployed on rails mounted from the ceiling. These rails surround a stationary operating table, allowing maintenance of the surgical field during the procedure. Patients can be scanned, treated percutaneously or surgically, and scanned again to verify treatment — without ever moving the patient or the operating table.
iMRI technology also has other benefits. For instance, during the removal of large tumors, significant shifts occur in brain tissue, limiting the accuracy of preoperatively acquired images. "The real-time visualization of the operative site with iMRI identifies both residual tumor and its relationship to the surrounding brain, improving our ability to distinguish tumor margins and allowing immediate modification of the surgical plan as needed," says Garton. "Even with large tumors, this reduces the need for re-operation."
Although iMRI technology has been available for some years, the first-generation machines were extremely bulky and image quality was often inadequate for the fine detail required when performing brain, spinal cord or other delicate procedures. "This technology at U-M is giving a wide range of surgical specialists — including in neurosurgery, neurology, neuro-oncology, radiation oncology, otolaryngology and ophthalmology — new tools to improve patient outcomes, reduce the risk of injury and eliminate the need for re-operations," says Garton. "We are already exploring all the ways that the iMRI can help improve patient outcomes in a variety of procedures beyond tumor resection surgery at U-M."