Dove Medical Press
Supplementary Information: Table 1. Demographic and Clinical Data of the Patients Operated for Spine and Spinal Cord Pathologies Under Intra-operative Magnetic Resonance Imaging GuidanceAuthors/yearAge (year)/ genderDiagnosisSurgival level(s)Preoperative treatment(s)Additional intra-operative assistive toolioMRI settingioMRI strength (T) ioMRI resultOutcomePoints to considerBlack et al./199777/MCervical myelopathy (operated with laminectomy)C3-C4N/AN/AOT0.5N/AN/AN/A(N/A for other 2 patients)Cervical extra-axial cyst* (all patients operated with laminectomy)Cervical*N/AN/AOT0.5N/AN/AN/AAlexander et al./1997N/A (3 patients) Syringohydromyelia in 1 patientN/AN/AN/AOT0.5N/AN/AN/AHall et al./1998N/A (2 pediatric patients)Syringohydromyelia (operated with laminectomy and syringosubarachnoid shunt)Thoracic N/AN/AOT1.5N/AOne patient experienced shunt migration into the syrinx cavity 3 months after surgery and was reoperatedIncapability of measuring core body temperatureVerheyden et al./1999N/A (16 patients)Unstable vertebral fractures (treated with dorsal instrumentation)Thoracolumbar N/AN/AOT0.5 Location of screws and alignment of spine after correction was correlated with CT findings1 patient had temporary plexus irritation, 2 patients had aseptic seroma due to patient positioning and surgical technique used, respectivelyArtifact of spinal implants on MRI was assessed Hall et al./2000N/A (5 patients)1 recurrent lumbar disc herniation, 2 cervical and 2 thoracic syringosubarachnoid shunt placement (treated with laminectomies in all patients)2 cervical, 2 thoracic, 1 lumbarN/AN/AOT1.5Syrinx size decreased in all patients treated with syringosubarachnoid shunt placement No worsening of neurological deficits after surgery, clinical improvement was observed in all patients with syrinx N/ABellavia et al./200047/FIntradural/extradural arachnoid cystT12-L1--OT0.2Partial cyst decompressionNo recurrence of symptoms 1 year after the interventionN/AKaibara et al./200181/N/APlasmacytoma (treated with transoral decompression and posterior stabilization with autologous iliac crest graft)C2--OT1.5Adequate decompression was confirmedDied of renal failure shorty after surgeryN/A51/N/AMetastatic breast carcinoma (treated with transoral decompression and posterior stabilization with autologous iliac crest graft)C2--OT1.5Adequate decompression was confirmedSignificant improvement of myelopathy 9 months after surgery63/N/ABasilar invagination with Chiari type I malformation (treated with transoral decompression)C1--OT1.5Adequate decompression was confirmedSignificant improvement of myelopathy 6 months after surgeryWoodard et al./2001***78/MCervical spondylopathic myelopathy (treated with laminectomy)C3-C5--OT0.5Decompression confirmedN/ALarge coil diameter in some cases led to diminished resolution, variable resolution of small image volumes, finite working space, increased operating room time, availability of MR compatible instruments, limited bony discrimination, costs were considered as limitations.46/MRecurrent lumbar intervertebral disc herniation (treated with microdiscectomy)Left L4-L5--OT0.5Decompression equivocal due to small disc fragment sizeN/A33/MLumbar intervertebral disc herniation (treated with microdiscectomy)Left L4-L5 --OT0.5Decompression confirmedN/A37/MLumbar intervertebral disc herniation (treated with microdiscectomy)Left L4-L5--OT0.5Decompression confirmedN/A63/MCervical spondylosis with radiculopathy (treated with posterior cervical foraminotomies)Left C4-C5, C5-C6, C6-C7, right C5-C6--OT0.5Decompression could not be confirmed due to technical issuesN/A55/MCervical intervertebral disc herniation (treated with anterior discectomy and iliac crest allograft interbody fusion)C5-C6--OT0.5Decompression confirmedN/A27/MCervical intervertebral disc herniation (treated with anterior discectomy and iliac crest allograft interbody fusion with locking plate)C5-C6--OT0.5Decompression confirmedN/A44/FCervical intervertebral disc herniation (treated with anterior discectomy and iliac crest allograft interbody fusion with locking plate)C5-C6--OT0.5Decompression confirmedN/A36/FCervical intervertebral disc herniation (treated with C6 vertebrectomy and fibular allograft fusion with anterior plate osteosynthesis)C5-C6, C6-C7--OT0.5Decompression confirmedN/A49/MCervical foraminal stenosis and radiculopathy (treated with anterior C7 foraminotomy)C6-C7--OT0.5Decompression confirmedN/A36/FCervical intervertebral disc herniation (treated with C6 vertebrectomy and fibular allograft fusion with anterior plate osteosynthesis)C5-C6, C6-C7--OT0.5Decompression confirmedN/A47/FCervical spondylopathic myelopathy (treated with C6 vertebrectomy and fibular allograft fusion with anterior plate osteosynthesis)N/A--OT0.5Decompression confirmedN/AMastronardi et al./200754**/26 M, 21 F (47 patients)Cervical spondylotic myelopathy (treated with anterior decompression)Single-level in 39 patients, two-level in 8 patientsN/A-OT1.5All patients were observed to have decompression, regression of T2 signal hiperintensity in 4 patients immediately after decompressionPatients with pre-operative only T2 hiperintensity had regression of signals, patients with pre-operative both T1 hipointensity and T2 hiperintensity had no regression and had the worst clinical outcomesRemaining posterior longitudinal ligament, small amounts of blood, hemostatic compounds result in difficulties to assess decompression adequacy of spinal canalSutherland et al./2008N/A (28 patients)Degenerative (16 patients) and neoplastic lesions (12 patients)Upper cervical spineN/AN/AOT1.5Residual tumor or incomplete decompression was seen in 18% of the patientsN/AN/ADuprez et al./200826/MIntramedullary glial tumorC5/C6-T7N/AN/ADR3.0N/AN/ADue to inexperience with spinal cases, multiple attempts to put the MR coil properly prior to imaging44/FEpendymomaT1-T2N/AN/ADR3.0No residual tumorN/AAir bubbles trapped inside the spinal cord mimicked epidural hemosiderin cap of ependymoma48/MEpendymomaC0-T7N/AN/ADR3.0Diffusion tensor imaging was used in addition to routine imaging modalitiesN/AAir bubbles trapped inside the spinal cord, enhancement of resection cavity in early phase of imaging, almost complete filling of cavity with contrast material 42 minutes after I.V. administrationLevy et al./2009N/A (5 pediatric patients) Plexiform neurofibroma (1 patient), tancytic epndymoma (1 patient), hemangioblastoma (1 patient), glioblastoma multiforme (1 patient), cervicothoracic syrinx (1 patient, treated with syringosubarachnoid shunt insertion)Cervicothoracic in 1 patient, N/A in other patientsN/ANeuronavigation (mentioned for all cohort combined with cranial cases, yet not clear specifically if it was used for spinal cases)OT1.5Intraoperative imaging prior to skin incision revealed tancytic ependymoma had increased in size, intradissection imaging was performed for tancytic ependymoma and hemangioblastoma tumors, no surgical re-exposure was made after imaging; no acute adverse events happenedN/AN/AHall et al./2010N/A (32 patients)Cervical spine pathologies for one of which posterior approach was preferred for intramedullary tumor biopsyCervicalN/AN/AN/AN/AN/AN/AN/ANetuka et al./201128/MIntramedullary cavernous malformationaC2-C5-SEP, MEPDR3.0An inferiorly located cyst was observed that was not accessed at the first attempt, in the second part of the surgery that cyst was aspiratedPost-operative new neurological deficits developed, 1 year after the surgery there was mild pain hypesthesia in the lower abdomen and pallanesthesia from the T12 level Only one of the two coils were used, which led to low quality images Lang et al./201137/MN/AC1-C2 (transoral decompression)N/AN/AOT3.0N/AN/AN/A9/MN/AC3 (transoral corpectomy)N/AN/AOT3.0N/AN/AN/ADhaliwal et al./2012 50**/ 10 M, 10 F (20 patients)Chordoma, osteochondroma, plasmacytoma, metastasis, chiari malformation, basilar invagination, rheumatoid arthritis, inflammatory pannus, post-traumatic (treated with transoral approach)Craniovertebral junction (ventral extradural lesions)Trial of pre-operative traction in 5 patientsNeuronavigationOT3.0Residual tumor was observed in 3 patients, which were removed in the same session with confirmation of gross resection, iatrogenic incomplete spinal cord injury was seen in one patient (actual cause was thought to be neuronavigation failure)19 patients had posterior approach after transoral approach, posterior decompression was performed in 67% of patients, one patient had durotomy during posterior approach; 92% of patients had neurological improvement (mean follow-up was 1.8 years), 2 patients died due to tumor progression (chordoma) and 1 patient died due to renal failure, one patient required revision surgery 7 months later for failed posterior implant, 5 patients needed rehabilitationRetractors had to be taken away before ioMRI acquisitionGiordano et al./201431/FIntramedullary low-grade astrocytomaC4-C6Prior surgery and adjuvant RT 1 year agoMEPOT1.5Residual tumor was observed and resected in the second part of the surgery; 2nd ioMRI showed further reduction of tumor massPost-operative transient worsening sensory deficitT2-weighted MR scans had image artifacts; new coil design for spinal surgery was recommended 6/FIntramedullary anaplastic oligoastrocytomaMedulla oblongata and 4th ventricle-T3NoneSEP, MEPOT1.5Residual lesion was observed at C1-C2 and resectedTransient worsening of motor deficit, improvement of dysphagia, referred to pediatric oncologist for adjuvant therapyT2-weighted MR scans had image artifacts; new coil design for spinal surgery was recommended N/APresent case44/FIntramedullary low-grade astrocytomaC2-C5-SEP, MEPDR1.5Residual lesion was observed and resected in the 2nd part of the surgeryN/AT2-weighted MR scans had image artifacts; new coil design for spinal surgery was recommended N/AAbbreviations: F: female, M: male, ioMRI: intra-operative magnetic resonance imaging, CT: computed tomography, RT: radiotherapy, SEP: somatosensorial evoked potential, MEP: motor evoked potential, OR: operative theater, DR: double room as MRI clinical unit and operative theater, T: Tesla, N/A: not available, I.V.: intravenous, a: Histopathology could not confirm the diagnosis exactly, *: Diagnosis and spinal level of the last patient was not mentioned in the original text, **: mean value, ***: One of the patients with cervical pathology was also mentioned in another paper published by the same group.References: Alexander E 3rd, Moriarty TM, Kikinis R, Black P, Jolesz FM. Stereotact The present and future role of intraoperative MRI in neurosurgical procedures. Funct Neurosurg.?1997;68(1-4 Pt 1):10-7. PMID:9711689Claus EB, Horlacher A, Hsu L, Schwartz RB, Dello-Iacono D, Talos F, Jolesz FA, Black PM. Survival rates in patients with low-grade glioma after intraoperative magnetic resonance image guidance. Cancer. 2005 Mar 15;103(6):1227-33. PMID:15690327Dhaliwal PP, Hurlbert RJ, Sutherland GS. Intraoperative magnetic resonance imaging and neuronavigation for transoral approaches to upper cervical pathology. World Neurosurg.?2012?Jul;78(1-2):164-9. PMID:22120262Duprez?TP, Jankovski A, Grandin C, Hermoye L, Cosnard G, Raftopoulos C. Intraoperative 3T MR imaging for spinal cord tumor resection: feasibility, timing, and image quality using a "twin" MR-operating room suite. AJNR Am J Neuroradiol.?2008?Nov;29(10):1991-4. PMID:18617591Giordano?M, Gerganov VM, Metwali H, Fahlbusch R, Samii A, Samii M, Bertalanffy H. Feasibility of cervical intramedullary diffuse glioma resection using intraoperative magnetic resonance imaging. Neurosurg Rev. 2013 Nov 15. PMID:24233260Hall WA, Liu H, Martin AJ, Pozza CH, Maxwell RE, Truwit CL. Safety, efficacy, and functionality of high-field strength interventional magnetic resonance imaging for neurosurgery. Neurosurgery.?2000?Mar;46(3):632-41; discussion 641-2. PMID:10719860Hall WA, Martin AJ, Liu H, Pozza CH, Casey SO, Michel E, Nussbaum ES, Maxwell RE, Truwit CL. High-field strength interventional magnetic resonance imaging for pediatric neurosurgery. Pediatr Neurosurg.?1998?Nov;29(5):253-9. PMID:9917543Hall WA, Truwit CL. Intraoperative magnetic resonance imaging. Acta Neurochir Suppl. 2011;109:119-29. PMID:20960331Kaibara?T, Hurlbert RJ, Sutherland GR. Intraoperative magnetic resonance imaging-augmented transoral resection of axial disease. Neurosurg Focus.?2001?Feb 15;10(2):E4. PMID: 16749751Lang MJ, Kelly JJ, Sutherland GR. A moveable 3-Tesla intraoperative magnetic resonance imaging system. Neurosurgery.?2011?Mar;68(1 Suppl Operative):168-79. PMID:21150476Levy R, Cox RG, Hader WJ, Myles T,?Sutherland?GR, Hamilton MG. Application of?intraoperative?high-field?magnetic resonance imaging?in pediatric neurosurgery. J Neurosurg Pediatr. 2009 Nov;4(5):467-74. PMID:19877782Netuka?D, Ostr? S, Bel?án T, Kramá? F, Bene? V. Intraoperative MR imaging in a case of a cervical spinal cord lesion. J Neurosurg Spine.?2011?Jun;14(6):754-7. PMID:21417698Percutaneous aspiration of an intradural/extradural thoracic arachnoid cyst: use of MR imaging guidance. Bellavia?R, King JT Jr, Naheedy MH, Lewin JS. J Vasc Interv Radiol.?2000?Mar;11(3):369-72. PMID:10735434Sutherland GR, Latour I, Greer AD. Integrating an image-guided robot with intraoperative MRI: a review of the design and construction of neuroArm. IEEE Eng Med Biol Mag.?2008?May-Jun;27(3):59-65. PMID:18519183 ................
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