MRgLITT under general anesthesia using extended non-ferromagnetic components in a non-MR-compatible environment-a case report

Authors: Yang Z et al.

BMC Anesthesiol (2026). https://doi.org/10.1186/s12871-026-03692-4

Summary

This case report published in BMC Anesthesiology describes an innovative anesthesia solution for magnetic resonance–guided laser interstitial thermal therapy (MRgLITT) in a facility without MR-conditional anesthesia equipment.

MRgLITT is a minimally invasive neurosurgical technique performed inside an MRI scanner. Because the procedure is prolonged and requires absolute immobility, general anesthesia (GA) with endotracheal intubation (ETT) and MR-compatible ventilatory support is typically recommended.

Clinical Challenge

The institution lacked:

• A hybrid MRI operating room

• MR-compatible anesthesia machine

• MR-conditional ventilator and monitoring systems

Case Details

A 43-year-old male (ASA II) with epilepsy and cavernous hemangioma underwent elective MRgLITT.

To safely deliver GA inside the MRI suite, the team adapted extended-length, MR-safe components to allow conventional anesthesia and monitoring equipment to remain outside the magnet room.

Modifications included:

• Prolonged breathing circuit

• Extended pulse oximeter cable

• Extended NIBP air tubing

• Extended capnography sampling line

This configuration allowed standard ventilators and monitors to operate outside the MRI environment while maintaining continuous physiologic monitoring in accordance with ASA MRI anesthesia recommendations (heart rate, pulse oximetry, blood pressure, capnography).

Safety Verification

Before full implementation, the team performed:

• Pre-procedural testing during the first phase of the case

• Parallel validation against standard monitoring equipment

• Arterial blood gas analysis to confirm adequate ventilation

The patient remained hemodynamically stable and recovered uneventfully.

Clinical Implications

This report demonstrates that in resource-constrained settings, carefully engineered adaptations using non-ferrous, extended-line components can provide safe anesthesia and monitoring support inside MRI suites.

However, the authors emphasize:

• Strict adherence to MRI safety principles

• Rigorous pre-use validation

• Objective testing of monitoring reliability

• Verification of ventilation with ABG

This approach may be particularly useful for centers expanding into MR-guided neurosurgical procedures without immediate access to MR-compatible anesthesia infrastructure.

What You Should Know

1. MRgLITT typically requires full GA in a high-risk MRI environment.

2. Extended MR-safe tubing allows conventional machines to remain outside the magnet room.

3. Objective validation (including ABGs) is essential before clinical implementation.

4. MRI anesthesia demands meticulous preparation due to limited patient access and magnetic hazards.

5. This model offers a practical framework for similar resource-limited institutions.

Key Points

• GA successfully delivered during MRgLITT without MR-conditional anesthesia machine.

• Extended non-ferrous lines enabled remote ventilation and monitoring.

• Safety confirmed through structured pre-procedural testing.

• Practical solution for resource-constrained MR-guided neurosurgical programs.

Thank you to BMC Anesthesiology for allowing us to summarize and share this innovative anesthesia management strategy in the MRI environment.