Intraoperative MRI Utilization by Moving Patients to the Magnet: Results From a Prospective Series of Brain Tumor Operations

TL;DR

This study shows that moving brain tumor surgery patients to an MRI scanner instead of moving the scanner into the operating room significantly increases the use of intraoperative MRI without affecting surgical efficiency.

Contribution

The study introduces a novel workflow for iMRI by moving patients to the magnet and using recovery room extubation to reduce OR time.

Findings

Moving patients to the magnet increased iMRI utilization from 22% to 100% in subsequent phases.

Phase-2 reduced case duration by 78 minutes and anesthesia time by 41 minutes compared to Phase-0.

Post-surgical MRI acquisition times decreased by 11 hours in both Phase-1 and Phase-2 compared to Phase-0.

Abstract

Background and objectives

Intraoperative magnetic resonance imaging (iMRI) is valuable for assessing the extent of brain tumor resections and preventing repeat procedures for unexpected residual tumors. However, prolonged procedure times and restrictions on ferromagnetic materials deter widespread iMRI use. This study explored two methods to increase iMRI utilization, both involving transferring patients to the magnet after wound closure rather than moving the magnet into the operating room (OR).

Methods

A process improvement database of 40 consecutive patients undergoing iMRI for brain tumor surgery was analyzed. Phase-1, conducted between November 2020 and February 2021, involved transporting patients to the magnet and returning them to the OR for extubation. Phase-2, conducted between August 2021 and November 2021, designated an extubation area in the recovery room, eliminating the need to return patients to the OR. Diagnosis was used to match Phase-1 and Phase-2 cohorts with a retrospective comparative cohort (Phase-0) collected between June 2019 and August 2019. Several time intervals were recorded for analysis.

Results

A total of 57 cases were analyzed; 56% of patients were male, with a mean age of 56 years. iMRI volumes significantly increased in Phase-1 (100%, n = 20) and Phase-2 (100%, n = 19) compared to Phase-0 (22%, n = 4, p < 0.001). OR occupancy (p = 0.18) and anesthesia duration (p = 0.23) were statistically similar between groups, but the Phase-2 group demonstrated a clinically relevant median decrease of 78 minutes in case duration and a 41-minute reduction in anesthesia duration compared to Phase-0. Both Phase-1 and Phase-2 showed a significant 11-hour decrease in post-surgical MRI acquisition times compared to Phase-0 (p < 0.001).

Conclusion

Transferring patients to the magnet significantly increased iMRI utilization and facilitated immediate postoperative imaging without negatively impacting OR efficiency or anesthetic safety. Establishing an extubation site in the recovery room saved valuable OR time and reduced patient intubation time. The practice of “moving the patient, not the magnet,” combined with recovery room extubation, is now routine in our neurosurgery service.

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