The Real Impact of an Intraoperative Magnetic Resonance Imaging?Equipped Operative Theatre in Neurovascular Surgery: The Sapienza University Experience

The fundamental role of technological instruments in contemporary Neurosurgery is undisputed, and intraoperative magnetic resonance imaging (MRI) represents one of the best examples. The use of a modern high-field magnet and the possibility to match the MRI with an operative microscope and an integrated neuronavigation system has led to successful results in the surgical treatment of different diseases. At our institute, we have performed surgery routinely with the aid of intraoperative MRI over the last 15 years. The aim of this article is to report our experience in the management of neurovascular lesions with the use of this device. We experienced that intraoperative MRI enhanced the surgical experience, leading to an improved postoperative outcome in the treatment of different lesions, such as arteriovenous malformations, dural arteriovenous fistulas, intracranial cavernous angiomas, and intracranial aneurysms. There are several advantages provided by the use of intraoperative MRI. The use of intraoperative MRI coupled with the planning station and the neuronavigation system allows one to obtain preoperative 3-dimensional reconstructions of the vessels, which aids the definition of the anatomy of each neurovascular lesion. Furthermore, the possibility performing an intraoperative scan allows a comparison with preoperative images and, subsequently, the updating of the surgical strategy. Intraoperative diffusion-weighted imaging can detect possible territorial ischemia that would be amenable to intensive treatment. Although increased costs, increased surgical times, increased anesthesiology times, and the possible increased risk of surgical infection may represent some major limitation, the use of intraoperative MRI–equipped operative theaters with integrated neuronavigation systems can prove extremely helpful in the management of neurovascular conditions.