From the April 2018 issue of HealthCare Business News magazine


Like other applications of iMRI, accuracy remains one of the biggest benefits. Traditionally, imaging is conducted at a preoperative stage, and surgeons are required to make decisions about targets and trajectories prior to the skull being opened and the brain exposed. Between the time the images are captured and the surgeon operates, a shift in the brain may occur at the point when a hole is made in the skull, and surgeons must do their best to estimate this shift and approach their targets accordingly. Dr. Golby, who specializes in craniotomies, mentions that, “brain shifts are the bane of our work.”

Without a direct validation of the target through intraoperative imaging, traditionally surgeons must make multiple electrode passes, indirectly validating targets by patient participation, stimulating the brain and measuring the patient reaction. With each pass of a microelectrode, patients run the inherent risk of a hemorrhage, and awake DBS often requires three to five passes per side.


Patient anxiety about being awake for the experience has posed problems as well, and some have even opted out of the surgery altogether. With asleep DBS and iMRI, Dr. Cosgrove is able to operate on patients without requiring their participation during the surgery and access enhanced imaging during surgery to identify and directly validate targets for one clean pass. Beyond improved outcomes, patients benefit from not having to cognitively endure the lengthy surgery and surgical teams can more easily manage blood pressure and other vitals.

Efficiency is an added benefit Dr. Cosgrove experienced after introducing iMRI to his practice, reducing DBS surgery time from between four and five hours to now doing it in three. That extra hour or two saved allows him to perform two procedures in a single day, becoming more efficient for the benefit of his patients and the hospital.

“If you want to provide the most effective care, especially as a functional neurosurgeon, intraoperative MRI is a marvelous technological advance. I will never treat movement disorder patients now without it,” says Dr. Cosgrove.

The future of intraoperative MRI
Both Dr. Cosgrove and Dr. Golby agree that intraoperative MRI will only continue to provide higher value for hospitals as workflows and applications continue to become more efficient, expand and improve. Hospitals considering this type of development should, of course, evaluate the investment carefully. First and foremost, surgical teams and administrators need to outline very clearly what the goals are and become informed about the possible applications, required training, maintenance and the impact on workflow.

April 2018 Magazine

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