Abstract SNACC-100

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Interventional MRI for functional neurosurgery: an audit of our practice

Luoma V, Wilson S, Waraich M
NHNN, London, , United kingdom

Introduction:
Deep Brain Stimulation (DBS)surgery in an Interventional MRI (iMRI) suite is relatively new. At our institution functional neurosurgery moved to the iMRI suite in 2011 when we opened the first unit in the UK. Prior to this, surgery was performed in the operating theatre with transfers to the radiology department for MRI scanning pre and intraoperatively [1]. This reflected on the operative time with 40 cases performed per year. The majority of our patients have a general anaesthetic for the procedure and undergo insertion of both electrodes and battery in the same setting [2,3] Our aim was to review the employment of iMRI for functional neurosurgery at our institution and to see how our practice has changed as a result.

Methods:
Patients who had undergone functional neurosurgery between Jan 2013 and Dec 2013 were identified using a database. Patients’ demographics, details of the surgical procedure and complications were then gathered from the case notes.

Results:
80 patients were identified. The median patient age was 55 (19-74) years with 64% [n=51] patients being male.The primary indication for DBS was Parkinson’s disease [table 1].The average surgical time in the iMRI suite was 3 hours and 29 minutes [SD +/- 2:05] which allowed an increase in our through put to 2 patients per day [graph 1].

We have had no significant peri-operative complications or safety issues as a result of operating in an iMRI suite. One patient had a grade 1 pressure sore,we believe this to be due to the iMRI operating table not being sufficiently padded to protect pressure areas.


Conclusion:
We conclude that the use of iMRI for functional neurosurgery has reduced the total time needed for surgery by eliminating transfers to the MRI scanner. The system has increased our efficiency, allowing us to double our patient throughput in 2 years thus reducing waiting lists. We have had no major complications despite this being a relatively remote site.

References:
1. Foltynie, T. et al. MRI-guided STN DBS in Parkinson's disease without microelectrode recording: efficacy and safety. J Neurol, Neurosurg & Psych 2011 82,358–363

2. Bergese et al. Anaesthesia in the intraoperative MRI environment. Neurosurg Clin N Am 2009 ; 20:155-62.

3. Venkatraghavan l et al. Anaesthesia for DBS Curr Op in Anaes : October 2011 24 (5): 495–499

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