Fig. 10. The intraoperative image quality of the high-field system is clearly superior to that of the low-field system. Similar cases with right temporal lobe tumors, which were investigated by T2-weighted imaging with the 0.2-T (A) or the 1.5-T system (B).

aneurysm surgery opens a new field of immediate intraoperative therapy control (55).

Even now, it seems obvious that the patient investigated by intraoperative MRI is profiting from it. For a large group of patients, intraoperative imaging can replace early postoperative controls; when a tumor is completely removed with the aid of intraoperative imaging, the costs of repeated postoperative imaging and a potential second operation are saved. Of course, the cost of intraoperative MRI are high for a neurosurgical department; considering the beneficial effects, they may not be high when seen from the perspective of the national economy. Prospective cost-benefit studies for intraoperative MRI must be performed.

Today the intraoperative application of high-field MR with the integration of all kinds of functional and anatomical data, including sophisticated brain atlases, seems to be the major challenge for intraoperative imaging. Furthermore, robotic devices, assisting and improving the mechanical skills of the neurosurgeon, will be integrated. In the future, major advances may be also new developments in MR technology, such as extremely low-field MRI with magnetic field strengths of 10 mT. These techniques, relying on the so-called Over-hauser effect (68), may result in the realization of small, nearly invisible MR scanners, which will not impair surgical maneuvers. The advanced operating room of the future will include continuous and immediate imaging with integrated display of anatomy and function in a cartesian room, supporting the neurosurgeon without interfering with the surgical workflow.

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