Intra-operative surgeries in MRI scanners lead to more secure brain interventions

Skåne University Hospital has performed five intra-operative magnetic resonance imaging neurosurgeries while the patients were inside the MRI scanner. The new method means that neurosurgeries and other sensitive procedures can be performed with greater accuracy and thereby increasing safety for the patient.

During the first intra-operative magnetic resonance imaging surgery, the surgeons removed a sample of a tumour in a hard-to-reach area of the brain. During the second surgery, deep brain stimulation was performed. Deep brain simulation means that electrodes are implanted into the brain to produce electrical impulses that regulate abnormal impulses in connection to certain conditions, such as Parkinson's disease.

“We are very happy to be able to perform surgeries on our patients while they are laying inside the MRI scanner. The surgeries that we have performed so far have been successful. For me as a surgeon, it means that I can be completely sure that the electrodes I implant into the brain are placed in the exact position. We're talking about tenths of a millimetre. The method is also safer for the patient”, says Hjálmar Bjartmarz, senior consultant in neurosurgery at Skåne University Hospital.

First in Sweden

Intra-operative magnetic resonance imaging is already a common method in neurosurgeries that require extra precision. However, this is the first time it has been performed in Sweden with the patient inside the MRI scanner during the whole procedure. It is also one of the first times the method has been performed outside the United States, where patients have successfully undergone these kind of surgeries for several years.

Patient safety is increased

Usually, an MRI scanner is not placed in the operating room, which means that the patient needs to be transported to the scanner, or the scanner transported to the patient. At Skåne University Hospital, the patients used to be transported between different floors.

“Transporting an anesthetised patient back and forth is obviously a risk. Intra-operative MRI with the patient inside the scanner all the time reduces that risk and makes it safer for the patient. For example, in surgeries where we use laser ablation of tumours and epilepsy focus, the new method has enabled us to directly see if all the tumour tissue has disappeared.”

More operations

Soon, the method will also be used in a new study that uses laser surgery to remove brain tumours. Performing intra-operative MRI neurosurgeries with the patient inside the scanner will become more common, Hjálmar Bjartmarz believes.

“We are at the forefront in this area. I am convinced that intra-operative MRI surgeries will be used to treat even more diagnoses”, he says.

Facts: MRI scanner

The strength of the magnetic field is measured in the unit tesla. Most scanners in healthcare are at 1.5 test. The scanners used during surgery holds 3 tesla.

Some hospitals use a similar method with so-called hybrid wards, where a portable MRI scanner can be rolled into the ward to check the intervention before and after surgery.

The surgeries at Skåne University Hospital are performed in the examination room where the large MRI scanner is located. Therefore, a sterile "tent" is built around the patient to mimic the conditions in a traditional operating room.