Frameless stereotactic neurosurgery using intraoperative magnetic resonance imaging: Stereotactic brains biopsy

Thomas M. Moriarty, Alfredo Quinones-Hinojosa, Paul S. Larson, Eben Alexander, P. Langham Gleason, Richard B. Schwartz, Ferenc A. Jolesz, Peter McL Black

Research output: Contribution to journalArticle

76 Citations (Scopus)

Abstract

OBJECTIVE: To assess the application accuracy of intraoperative magnetic resonance imaging for frameless stereotactic surgery, and to evaluate the performance of intraoperative magnetic resonance imaging for the brain biopsy, a standard stereotactic procedure. METHODS: A series of spatial coordinate and phantom experiments were performed to analyze the application accuracy of the system. A prospective analysis of 68 consecutive patients undergoing stereotactic brain biopsy was then performed. RESULTS: The spatial coordinate experiments revealed a mean overall error in acquisition of 0.2 mm. The phantom experiments demonstrated a 1:1 correlation between the magnetic resonance image of a stereotactically guided probe and its relationship to a target and the actual relationship of the probe and target. Sixty-eight brain biopsies were successfully performed in all intracranial compartments except the sella. The radiographic abnormality was localized successfully in all patients (100%). Sixty-six (97.1%) of the biopsies yielded diagnostic tissue. Two biopsies (2.9%) were complicated by intraparenchymal hemorrhage. One expanding temporal lobe hemorrhage was evacuated by immediate craniotomy in the magnet with no postoperative sequelae. A deep hemorrhage from a lymphoma was managed conservatively with interval resolution of symptoms. There were no infections. There was no perioperative mortality. CONCLUSION: Intraoperative magnetic resonance imaging allows excellent target localization, provides true real-time imaging to account for anatomic changes during surgery, and permits intraoperative confirmation that the biopsy needle has reached the targeted lesion. Immediate postoperative imaging in the operating room allows assessment of adverse events and the potential for immediate management of hemorrhagic complications.

Original languageEnglish (US)
Pages (from-to)1138-1146
Number of pages9
JournalNeurosurgery
Volume47
Issue number5
StatePublished - 2000
Externally publishedYes

Fingerprint

Neurosurgery
Magnetic Resonance Imaging
Biopsy
Brain
Hemorrhage
Magnets
Craniotomy
Needle Biopsy
Temporal Lobe
Operating Rooms
Lymphoma
Magnetic Resonance Spectroscopy
Mortality
Infection

Keywords

  • Biopsy
  • Brain
  • Image-guided surgery
  • Intraoperative magnetic resonance imaging
  • Magnetic resonance imaging
  • Stereotaxy

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

Moriarty, T. M., Quinones-Hinojosa, A., Larson, P. S., Alexander, E., Gleason, P. L., Schwartz, R. B., ... Black, P. M. (2000). Frameless stereotactic neurosurgery using intraoperative magnetic resonance imaging: Stereotactic brains biopsy. Neurosurgery, 47(5), 1138-1146.

Frameless stereotactic neurosurgery using intraoperative magnetic resonance imaging : Stereotactic brains biopsy. / Moriarty, Thomas M.; Quinones-Hinojosa, Alfredo; Larson, Paul S.; Alexander, Eben; Gleason, P. Langham; Schwartz, Richard B.; Jolesz, Ferenc A.; Black, Peter McL.

In: Neurosurgery, Vol. 47, No. 5, 2000, p. 1138-1146.

Research output: Contribution to journalArticle

Moriarty, TM, Quinones-Hinojosa, A, Larson, PS, Alexander, E, Gleason, PL, Schwartz, RB, Jolesz, FA & Black, PM 2000, 'Frameless stereotactic neurosurgery using intraoperative magnetic resonance imaging: Stereotactic brains biopsy', Neurosurgery, vol. 47, no. 5, pp. 1138-1146.
Moriarty, Thomas M. ; Quinones-Hinojosa, Alfredo ; Larson, Paul S. ; Alexander, Eben ; Gleason, P. Langham ; Schwartz, Richard B. ; Jolesz, Ferenc A. ; Black, Peter McL. / Frameless stereotactic neurosurgery using intraoperative magnetic resonance imaging : Stereotactic brains biopsy. In: Neurosurgery. 2000 ; Vol. 47, No. 5. pp. 1138-1146.
@article{de6111749b6748b082eb67e3a0531d71,
title = "Frameless stereotactic neurosurgery using intraoperative magnetic resonance imaging: Stereotactic brains biopsy",
abstract = "OBJECTIVE: To assess the application accuracy of intraoperative magnetic resonance imaging for frameless stereotactic surgery, and to evaluate the performance of intraoperative magnetic resonance imaging for the brain biopsy, a standard stereotactic procedure. METHODS: A series of spatial coordinate and phantom experiments were performed to analyze the application accuracy of the system. A prospective analysis of 68 consecutive patients undergoing stereotactic brain biopsy was then performed. RESULTS: The spatial coordinate experiments revealed a mean overall error in acquisition of 0.2 mm. The phantom experiments demonstrated a 1:1 correlation between the magnetic resonance image of a stereotactically guided probe and its relationship to a target and the actual relationship of the probe and target. Sixty-eight brain biopsies were successfully performed in all intracranial compartments except the sella. The radiographic abnormality was localized successfully in all patients (100{\%}). Sixty-six (97.1{\%}) of the biopsies yielded diagnostic tissue. Two biopsies (2.9{\%}) were complicated by intraparenchymal hemorrhage. One expanding temporal lobe hemorrhage was evacuated by immediate craniotomy in the magnet with no postoperative sequelae. A deep hemorrhage from a lymphoma was managed conservatively with interval resolution of symptoms. There were no infections. There was no perioperative mortality. CONCLUSION: Intraoperative magnetic resonance imaging allows excellent target localization, provides true real-time imaging to account for anatomic changes during surgery, and permits intraoperative confirmation that the biopsy needle has reached the targeted lesion. Immediate postoperative imaging in the operating room allows assessment of adverse events and the potential for immediate management of hemorrhagic complications.",
keywords = "Biopsy, Brain, Image-guided surgery, Intraoperative magnetic resonance imaging, Magnetic resonance imaging, Stereotaxy",
author = "Moriarty, {Thomas M.} and Alfredo Quinones-Hinojosa and Larson, {Paul S.} and Eben Alexander and Gleason, {P. Langham} and Schwartz, {Richard B.} and Jolesz, {Ferenc A.} and Black, {Peter McL}",
year = "2000",
language = "English (US)",
volume = "47",
pages = "1138--1146",
journal = "Neurosurgery",
issn = "0148-396X",
publisher = "Lippincott Williams and Wilkins",
number = "5",

}

TY - JOUR

T1 - Frameless stereotactic neurosurgery using intraoperative magnetic resonance imaging

T2 - Stereotactic brains biopsy

AU - Moriarty, Thomas M.

AU - Quinones-Hinojosa, Alfredo

AU - Larson, Paul S.

AU - Alexander, Eben

AU - Gleason, P. Langham

AU - Schwartz, Richard B.

AU - Jolesz, Ferenc A.

AU - Black, Peter McL

PY - 2000

Y1 - 2000

N2 - OBJECTIVE: To assess the application accuracy of intraoperative magnetic resonance imaging for frameless stereotactic surgery, and to evaluate the performance of intraoperative magnetic resonance imaging for the brain biopsy, a standard stereotactic procedure. METHODS: A series of spatial coordinate and phantom experiments were performed to analyze the application accuracy of the system. A prospective analysis of 68 consecutive patients undergoing stereotactic brain biopsy was then performed. RESULTS: The spatial coordinate experiments revealed a mean overall error in acquisition of 0.2 mm. The phantom experiments demonstrated a 1:1 correlation between the magnetic resonance image of a stereotactically guided probe and its relationship to a target and the actual relationship of the probe and target. Sixty-eight brain biopsies were successfully performed in all intracranial compartments except the sella. The radiographic abnormality was localized successfully in all patients (100%). Sixty-six (97.1%) of the biopsies yielded diagnostic tissue. Two biopsies (2.9%) were complicated by intraparenchymal hemorrhage. One expanding temporal lobe hemorrhage was evacuated by immediate craniotomy in the magnet with no postoperative sequelae. A deep hemorrhage from a lymphoma was managed conservatively with interval resolution of symptoms. There were no infections. There was no perioperative mortality. CONCLUSION: Intraoperative magnetic resonance imaging allows excellent target localization, provides true real-time imaging to account for anatomic changes during surgery, and permits intraoperative confirmation that the biopsy needle has reached the targeted lesion. Immediate postoperative imaging in the operating room allows assessment of adverse events and the potential for immediate management of hemorrhagic complications.

AB - OBJECTIVE: To assess the application accuracy of intraoperative magnetic resonance imaging for frameless stereotactic surgery, and to evaluate the performance of intraoperative magnetic resonance imaging for the brain biopsy, a standard stereotactic procedure. METHODS: A series of spatial coordinate and phantom experiments were performed to analyze the application accuracy of the system. A prospective analysis of 68 consecutive patients undergoing stereotactic brain biopsy was then performed. RESULTS: The spatial coordinate experiments revealed a mean overall error in acquisition of 0.2 mm. The phantom experiments demonstrated a 1:1 correlation between the magnetic resonance image of a stereotactically guided probe and its relationship to a target and the actual relationship of the probe and target. Sixty-eight brain biopsies were successfully performed in all intracranial compartments except the sella. The radiographic abnormality was localized successfully in all patients (100%). Sixty-six (97.1%) of the biopsies yielded diagnostic tissue. Two biopsies (2.9%) were complicated by intraparenchymal hemorrhage. One expanding temporal lobe hemorrhage was evacuated by immediate craniotomy in the magnet with no postoperative sequelae. A deep hemorrhage from a lymphoma was managed conservatively with interval resolution of symptoms. There were no infections. There was no perioperative mortality. CONCLUSION: Intraoperative magnetic resonance imaging allows excellent target localization, provides true real-time imaging to account for anatomic changes during surgery, and permits intraoperative confirmation that the biopsy needle has reached the targeted lesion. Immediate postoperative imaging in the operating room allows assessment of adverse events and the potential for immediate management of hemorrhagic complications.

KW - Biopsy

KW - Brain

KW - Image-guided surgery

KW - Intraoperative magnetic resonance imaging

KW - Magnetic resonance imaging

KW - Stereotaxy

UR - http://www.scopus.com/inward/record.url?scp=0033759302&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0033759302&partnerID=8YFLogxK

M3 - Article

C2 - 11063107

AN - SCOPUS:0033759302

VL - 47

SP - 1138

EP - 1146

JO - Neurosurgery

JF - Neurosurgery

SN - 0148-396X

IS - 5

ER -