First clinical results of intraoperative high-field magnetic resonance imaging supported by neuronavigation Ch. Nimsky * , O. Ganslandt, B.v. Keller, L. Anker, J. Romsto ¨ck, R. Fahlbusch Department of Neurosurgery, University Erlangen-Nu ¨rnberg, Schwabachanlage 6, 91054 Erlangen, Germany Received 2 March 2003; received in revised form 2 March 2003; accepted 18 March 2003 Abstract A new setup for intraoperative imaging, combining the benefits of high-field magnetic resonance (MR) imaging with microscope-based neuronavigation, providing anatomical and functional guidance was established by adapting a rotating operating table to a 1.5 T MR scanner, placed in a radiofrequency-shielded operating theatre. The navigation microscope placed in the 5 G zone in combination with a ceiling mounted navigation system enables integrated microscope-based neuronavigation. A total of 126 patients, mainly gliomas and pituitary adenomas, were investigated. In 29% of all patients, intraoperative MR imaging resulted in a repeated inspection of the surgical field with a modification of the surgical strategy. In 62 patients, microscope-based navigation was used, in 21 functional data were integrated. Navigational accuracy was not impeded by the magnetic fringe field. Imaging quality was not disturbed by the operating environment; there was hardly a difference in imaging quality between pre- and intraoperative scans. Intraoperative workflow with patient transport for imaging was straightforward. We did not encounter any untoward events due to the high magnetic field. Standard high-field MR scanners can be successfully adapted to an operating environment including integrated neuronavigational support. Their intraoperative application offers increased image quality and a broad spectrum of different imaging modalities, compared to previous low-field systems. D 2003 Elsevier Science B.V. and CARS. All rights reserved. Keywords: Intraoperative high-field MR imaging; Glioma surgery; Pituitary surgery; Functional neuronavigation 0531-5131/03 D 2003 Elsevier Science B.V. and CARS. All rights reserved. doi:10.1016/S0531-5131(03)00457-6 * Corresponding author. Tel.: +49-9131-8534570; fax: +49-9131-8534551. E-mail addresses: nimsky@nch.imed.uni-erlangen.de (Ch. Nimsky), ganslandt@nch.imed.uni-erlangen.de (O. Ganslandt), keller@nch.imed.uni-erlangen.de (B. Keller), anker@nch.imed.uni-erlangen.de (L. Anker), romstoeck@nch.imed.uni-erlangen.de (J. Romsto ¨ck), fahlbusch@nch.imed.uni-erlangen.de (R. Fahlbusch). International Congress Series 1256 (2003) 601 – 606