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by Jie Tang and Ye Li, Xuanwu Hospital Neurosurgery Department

Beijing, China, April 5, 2019 — On the morning of March 1, 2019, Xuanwu Hospital Neurosurgery Department (China International Institute of Neuroscience, CHINA-INI) performed the first intracranial resection case under the guidance of a 3.0T high field intraoperative MRI system, which signifies the neurosurgery department of Xuanwu Hospital CHINA-INI has entered a new era of precision neurosurgery.

Figure 1 Director Jie Tang introduces the patient’s condition to President Guoguang Zhao

The principle of modern neurosurgical treatment for brain tumors is ‘the greatest degree of safe resection’. The high field iMRI system at Xuanwu Hospital Neurosurgery CHINA-INI has a moving magnet, which is safely separated from the operating room by an RF-shielded door. The magnet can be moved toward the operating room whenever necessary, assisting the surgeon in real-time to determine the degree of lesion resection and protect the important cerebral function.

The lesion is adjacent to important motor-related nerve fiber bundles.

The first patient for iMRI surgery showed one-sided dyskinesia and repeated seizures before operation. Imaging results indicated a left frontal cavernous vascular malformation. The preoperative plan of multimodality neuro-navigation indicated that the lesion was adjacent to and even partially destroyed important motor-related nerve fiber bundles.

Figure 2A: Preoperative imaging: Left frontal cavernous vascular malformation;
Figure 2B: Intraoperative imaging indicates complete resection of lesions

The advantages of the intraoperative MRI system are: the patient does not need to be moved and routine surgical instruments, microscopes, and navigation systems can be used, which ensures normal procedural operation and patient safety.

High field MRI effectively guarantees high quality intraoperative images, and provides real-time guidance and precise positioning.

With the assistance of the Anesthesia and Nursing teams, Neurosurgery Chief Physician, Jie Tang, removed the cranial lesions with high field iMRI and a multimodality neuro-navigation system. The intraoperative images indicated a total resection of the lesions and no neurological dysfunction was aggravated after operation. During the operation, with personal instruction from Professor Samii, President Guoguang Zhao, and Professor Feng Ling, and with support from Anesthesiology Director Tianlong Wang, and Chief Nurse, Ting Liu, Operating Rooms, we achieved the first iMRI case perfectly.

Figure 3 Top left: Director Jie Tang introduces the patient’s condition to President Guoguang Zhao; Top right: Performing pre-scan safety check; Bottom left: Preparing for intraoperative scanning; and Bottom right: RF shielding door is opened, magnet is moved into the operating room.

During the intraoperative scan, President Guoguang Zhao said, “The iMRI system is not only used in the neurosurgical operating room, but is also an important open platform combined with the cooperation of various disciplines including Imaging and Anesthesiology. Driven by innovation, the use of iMRI will inevitably deepen the intimate cooperation between disciplines and enrich the connotation of the construction of various disciplines.”

The intraoperative MRI system is an open platform with multidisciplinary intersections.

Jie Tang, iMRI system leader for Xuanwu Hospital Neurosurgery, CHINA-INI said, “In traditional surgery, due to intraoperative cerebrospinal fluid loss, brain tissue edema, or tumor resection and other factors ‘brain drift’ will occur. If the operation is guided by pre-operative images, there will be obvious deviation and it could even be misleading. High field iMRI provides the latest images during operation in real-time, correcting the ‘brain shift’ and maximizing resection, while protecting important structures of the brain, realizing real-time positioning, and enabling precise treatment.”

Figure 4  Professor Samii, President Guoguang Zhao, Professor Feng Ling, Chief Physician Jie Tang, Director Tianlong Wang, Chief Nurse Ting Liu, and the neurosurgical team commemorated the accomplishment of their first iMRI case at CHINA-INI.

“The application of high field iMRI of CHINA-INI not only maintains the ‘maximum safe resection of tumors’, it will also be an important opening platform for image-guided surgery and brain function research for CHINA-INI. We will further integrate iMRI guided focused ultrasound therapy, tumor cryoablation and laser surgery, and other international advanced minimally invasive treatment technologies to provide the most advanced medical services for patients. We have established a multidisciplinary medical research team specializing in neurosurgery, biomedical engineering, and computer-aided medical image processing, providing unlimited power for neuroscience research and guiding us to explore the mysteries of the brain.”

— Hongqi Zhang, Director of Neurosurgery, Xuanwu Hospital