Intraoperative MRI without an intraoperative MRI suite: a workflow for glial tumor surgery.

BACKGROUND: Intraoperative MRI (iMRI) has emerged as a useful tool in glioma surgery to safely improve the extent of resection. However, iMRI requires a dedicated operating room (OR) with an integrated MRI scanner solely for this purpose. Due to physical or economical restraints, this may not be feasible in all centers. The aim of this study was to investigate the feasibility of using a non-dedicated MRI scanner at the radiology department for iMRI and to describe the workflow with special focus on time expenditure and surgical implications. METHODS: In total, 24 patients undergoing glioma surgery were included. When the resection was deemed completed, the wound was temporarily closed, and the patient, under general anesthesia, was transferred to the radiology department for iMRI, which was performed using a dedicated protocol on 1.5 or 3 T scanners. After performing iMRI the patient was returned to the OR for additional tumor resection or final wound closure. All procedural times, timestamps, and adverse events were recorded. RESULT: The median time from the decision to initiate iMRI until reopening of the wound after scanning was 68 (52-104) minutes. Residual tumors were found on iMRI in 13 patients (54%). There were no adverse events during the surgeries, transfers, transportations, or iMRI-examinations. There were no wound-related complications or infections in the postoperative period or at follow-up. There were no readmissions within 30 or 90 days due to any complication. CONCLUSION: Performing intraoperative MRI using an MRI located outside the OR department was feasible and safe with no adverse events. It did not require more time than previously reported data for dedicated iMRI scanners. This could be a viable alternative in centers without access to a dedicated iMRI suite.

Successful adaptation of twinning concept for global neurosurgery collaborations-a validation study.

INTRODUCTION: Globally, many regions have an urgent, unmet need of neurosurgical care. A multi-step neurosurgical twinning technique, International Neurosurgical Twinning Modeled for Africa (INTIMA), was proved to be successful during a previous mission to Neurosurgical Unit, Enugu, Nigeria. The Swedish African Neurosurgical Collaboration (SANC) performed a developmental mission together with the local neurosurgical unit in The Gambia, adopting the INTIMA model. METHODS: A multidisciplinary team visited for a 2-week collaborative mission at the Neurosurgical Department of the Edward Francis Small Teaching Hospital in Banjul, The Gambia. The mission followed the data of neurosurgical operations during and after the mission as well as about the operations 3 months prior to and after the mission was collected. RESULTS: During the mission, a total of 22 operations was carried out, the most common being degenerative spinal conditions (n = 9). In the 3 months following the mission, 43 operations were performed compared to 24 during the 3 months leading up to the mission. The complexity of the performed procedures increased after the mission. An operating microscope (Möller-Wedel) was donated and installed and the neurosurgeons on site underwent training in microneurosurgery. The surgical nurses, nurses at the postoperative ward, and the physiotherapists underwent training. A biomedical engineer serviced multiple appliances and devices improving the patient care on site while training local technicians. CONCLUSION: This study validated the use of the INTIMA model previously described in a mission by Swedish African Neurosurgical Collaboration (SANC). The model is sustainable and produces notable results. The core strength of the model is in the multidisciplinary team securing all the aspects and steps of the neurosurgical care. Installation of an operating microscope opened for further microsurgical possibilities, improving the neurosurgical care in The Gambia.

Learning Curve Analysis and Adverse Events After Implementation of Neurosurgical Laser Ablation Treatment: A Population-Based Single-Institution Consecutive Series.

OBJECTIVE AND METHODS: We conducted a retrospective review of the first 30 patients treated with stereotactic laser ablation (SLA) at our institution since the introduction of the technique in September 2019. We aimed to analyze our initial results and potential learning curve by investigating precision and lesion coverage and assessing the frequency and nature of adverse events according to the Landriel-Ibanez classification for neurosurgical complications. RESULTS: Indications were de novo gliomas (23%), recurrent gliomas (57%), and epileptogenic foci (20%). There was a trend toward improvement of lesion coverage and target deviation, and a statistically significant improvement in entry point deviation, over time. Four patients (13.3%) experienced a new neurological deficit, where three patients had transient and one patient had permanent deficits, respectively. Our results show a learning curve on precision measures over the first 30 cases. Based on our results the technique can safely be implemented at centers with experience in stereotaxy.