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64th Annual Meeting of the German Society of Neurosurgery (DGNC)

German Society of Neurosurgery (DGNC)

26 - 29 May 2013, Düsseldorf

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Intraoperative high-field magnetic resonance imaging, multimodal navigation and intraoperative electrophysiological monitoring guided surgical treatment of cerebrovascular diseases

Meeting Abstract

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  • Fang-ye Li - Department of Neurosurgery, PLA General Hospital, Beijing, China
  • Xiao-lei Chen - Department of Neurosurgery, PLA General Hospital, Beijing, China
  • Guo-chen Sun - Department of Neurosurgery, PLA General Hospital, Beijing, China
  • Jia-shu Zhang - Department of Neurosurgery, PLA General Hospital, Beijing, China
  • Jin-jiang Li - Department of Neurosurgery, PLA General Hospital, Beijing, China
  • Gang Zheng - Department of Neurosurgery, PLA General Hospital, Beijing, China
  • Ting Zhang - Department of Neurosurgery, PLA General Hospital, Beijing, China
  • Bai-Nan Xu - Department of Neurosurgery, PLA General Hospital, Beijing, China

Deutsche Gesellschaft für Neurochirurgie. 64. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC). Düsseldorf, 26.-29.05.2013. Düsseldorf: German Medical Science GMS Publishing House; 2013. DocP 013

doi: 10.3205/13dgnc434, urn:nbn:de:0183-13dgnc4343

Published: May 21, 2013

© 2013 Li et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

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Objective: Clinical application of intraoperative high-field magnetic resonance imaging (iMRI) and multimodal navigation in treatment of cerebrovascular diseases has been rarely reported. To systematically document the beneficial effect of intraoperative high-field MRI, multimodal navigation and intraoperative electrophysiological monitoring in surgical treatment of selected cerebrovascular diseases.

Method: Thirty-one patients with cerebrovascular diseases (13 supratentorial cavernomas, 11 brainstem cavernomas, 6 arteriovenous malformations (AVMs) and 2 distal aneurysms) were prospectively enrolled and operated with 1.5 T intraoperative MRI, multimodal navigation and intraoperative electrophysiological monitoring. All cavernomas were small (<2 cm), subcortically deep-seated or involving critical areas, while all AVMs involved eloquent structures. Intraoperative high-field MRI was obtained for intraoperative “visualization” of surrounding eloquent structures, “brain shift” correction, and navigational plan update.

Results: All cavernomas and AVMs were successfully resected with iMRI, multimodal navigation and intraoperative electrophysiological monitoring. In 5 cases with supratentorial cavernomas, intraoperative “brain shift” severely interfered with determining the location of the lesions. Intraoperative MR imaging helped to precisely relocate the lesion. In 1 brainstem cavernoma, the first intraoperative MRI scan demonstrated a lesion remnant, which needed further resection. Two distal aneurysms were successfully clipped with multimodal navigation. Intraoperative MRI excluded any intracranial hemorrhage or hyperacute infarction. Some or all presenting signs and symptoms improved or resolved in 18 cases during long-term (>3 months) follow-up.

Conclusions: Intraoperative high-field MRI, multimodal navigation and intraoperative electrophysiological monitoring are helpful for surgical treatment of selected cerebrovascular diseases, such as small subcortically deep-seated cavernomas or AVMs involving eloquent structures, as well as selected distal aneurysms.