Fig. 9. A 34-yr-old male patient with a right precentral WHO grade II astrocytoma. (A-C) Preoperative axial images. (D-F) Corresponding intraoperative images. (A,D) T1-weighted images. (B,E) T2-weighted images. (C,F) FLAIR images.
intraoperative MR images, on which we are working, will improve registration accuracy, leading to more reliable ongoing neuronavigational application accuracy, especially if the navigation data are updated during critical steps of the overall procedure.
The application of MR spectroscopy to delineate normal brain vs pathological tissue (60-63) and to delineate the tumor border, its integration into the navigational setup, and intraoperative spectroscopic measurements are important projects, which will open new avenues in the treatment of brain tumors. Furthermore, the integration of information on pathways, such as the pyramidal tract, is an important and challenging task (64). Updated intraoperative compensation for brain shift, not only concerning the standard anatomical information, but also including pathways and functional data has to be established (32,65). Mathematical models describing the brain shift phenomenon, based mainly on finite element technology, will aid in this process (66,67). Intraoperative high-field MRI may also have indications beyond resection control in tumor surgery, e.g., intraoperative MRI with MR angiography in combination with perfusion imaging to monitor surgical effects in angioma and
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