A New Artifact-free Device for Frameless, Magnetic Resonance Imaging-guided Stereotactic Procedures

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Abstract
A new, artifact-free, nonobstructive device was required for planning, guiding, and performing stereotactic procedures in an open magnetic resonance imaging (MRI) system (Signa SP; General Electric, Milwaukee, WI). We devised an MRI-compatible instrument set that was adapted to an optical triangulation system (FlashPoint System; Image Guided Technologies, Boulder, CO) and consisted of a Pathfinder for planning burr holes and trajectories and a Snapper-Stereoguide for guiding minimally invasive instruments such as biopsy cannulae, endoscopes, and laser fibers. The instruments were composed of biocompatible plastic (polyacetal). During evaluation, special attention was paid to safety, accuracy, operation times, and susceptibility artifacts of the system. The first 20 stereotactic procedures performed in the open MRI scanner included 15 biopsies, 1 cyst and 3 abscess evacuations, and 1 endoscopic procedure for treatment of multiseptate hydrocephalus. There were no adverse outcomes, and all biopsies were diagnostic. The frameless stereotactic system in combination with the FlashPoint System proved to be accurate, with a mean error of 1.5 mm. The biopsy devices did not cause any susceptibility artifacts. Highly vascularized structures were clearly visible and were included in the trajectory planning. With experience, the procedure time was reduced to less than 1 hour. This device was found to be quite helpful for planning and guiding stereotactic procedures in the open MRI scanner. Nearly real-time planning and monitoring of stereotactic procedures and the positional accuracy of the system make the open MRI system a definite improvement, compared with conventional stereotactic systems.