Intraoperative MRI in Skull Base Surgery: a review of 71 consecutive cases

• Published in: World neurosurgery 2016
• Main Authors: Ashour, Ramsey, MD, Reintjes, Stephen, MD, Park, Michael S., MD, Sivakanthan, Sananthan, BS, van Loveren, Harry, MD, Agazzi, Siviero, MD, MBA
• Format: Article
• Language: English
• Subjects: Neurosurgery
• ISSN: 1878-8750
• DOI: 10.1016/j.wneu.2016.06.045

Abstract Background Although intraoperative magnetic resonance imaging (iMRI) is increasingly utilized during glioma resection, its role in skull base surgery has not been well documented. In this study, we evaluate our experience with iMRI for skull base surgery. Methods Medical records were retrospectively reviewed on all neurosurgical cases performed at our institution in the IMRIS® iMRI suite between April 2014 and July 2015. Results Over the study period, the iMRI suite was utilized for 71 skull base tumors. iMRI was performed in 23/71 cases. Additional tumor resection was pursued after scanning in 7/23 patients. There was a significant difference in procedure length between the scanned vs non-scanned groups, and this was likely attributable to a higher proportion of petroclival meningiomas in the scanned group. Further analyses revealed significant increases in procedure length for the following scanned subgroups: anterolateral approach, anterolateral and petroclival lesion locations, and meningiomas. The rate of non-neurologic complications was significantly higher in the scanned group, particularly for patients with tumors >3cm. Conclusion Despite the unique challenges associated with skull base tumor surgery, iMRI can be safely obtained while adding a modest though not prohibitive amount of time to the procedure. The immediate evidence of residual tumor with a patient still in position to have additional resection may influence the surgeon to alter the surgical plan and attempt further resection in a critical area.