Concierge neurosurgical imaging · UK
Intraoperative MRI (iMRI), real-time MRI in theatre — improving safety and completeness of neurosurgery.
Intraoperative MRI (iMRI) integrates a high-field MRI scanner into the neurosurgical operating theatre. Real-time imaging during surgery improves the completeness of tumour resection and reduces the need for early re-operation — especially for glioma, pituitary and epilepsy surgery.
Why patients choose us
- 01
Specialist neurosurgical centres
We route you to consultant neurosurgeons in centres with a fully integrated intraoperative MRI theatre — not a retrofit.
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MDT-linked pre-operative planning
Your case is discussed at a neuro-oncology or pituitary MDT before theatre, with imaging and pathology reviewed together.
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Independent, and free
We are paid by no clinic, so the recommendation is impartial and costs you nothing.
Key facts
What intraoperative MRI is, in six lines.
The essentials — what iMRI is, where it sits in the surgical pathway, and why it changes outcomes.
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Definition
Real-time MRI integrated into the neurosurgical operating theatre.
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High-field scanner
1.5T or 3T MRI, MR-conditional theatre and instruments.
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Improves resection completeness
Increases the proportion of tumour removed at the first operation.
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Reduces re-operation for glioma
Fewer early returns to theatre for residual disease.
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Specialist centres only
Standard of care in tertiary neurosurgical units — not a district-general test.
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MDT-linked planning
Pre-operative imaging and neuronavigation planned with the MDT.
The problem
Brain surgery is only as good as what you can see, when you can see it.
Pre-operative imaging drifts once the skull is open. iMRI refreshes the picture at the critical moment — so the surgeon can decide whether the resection is really complete before you leave theatre.
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Newly diagnosed glioma?
We route you to a centre with an integrated iMRI theatre and a neuro-oncology MDT.
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Pituitary adenoma?
iMRI is particularly useful in transsphenoidal surgery for macroadenomas.
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Epilepsy surgery planned?
iMRI verifies the target and updates navigation intra-operatively.
The journey
From MDT to recovery — what happens, in order.
A neurosurgical, neuroanaesthetic and neuroradiology team around you from planning to post-op imaging.
Phase 1 · Before your surgery
MDT and planning
Phase 2 · On the day
In the iMRI theatre
Phase 3 · After
Post-op imaging and recovery
- 01
Before
Neurosurgical MDT consultation
Your case is reviewed by neurosurgery, neuro-oncology, neuroradiology and pathology together.
- 02
Before
Pre-op MRI and navigation planning
High-resolution MRI (± tractography, fMRI) is loaded into the neuronavigation system.
- 03
Before
Fast per anaesthetic protocol
You are fasted per the anaesthetic team’s instructions — usually 6 hours food, 2 hours clear fluids.
- 04
On the day
GA in MR-compatible theatre
General anaesthesia is delivered in an MR-conditional theatre with non-ferromagnetic equipment.
- 05
On the day
Intra-op imaging at critical stage
When the surgeon judges resection is complete, the scanner acquires images without moving you.
- 06
On the day
Real-time re-planning
If residual tumour is seen, the resection is extended safely within the same anaesthetic.
- 07
After
Post-op MRI before recovery
A final MRI documents the resection cavity before you leave theatre for recovery.
What it shows
What iMRI shows the surgical team.
iMRI answers a specific set of intra-operative questions — from residual tumour to vessels at risk — while you are still asleep.
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Residual tumour volume
Quantifies any tumour left behind at the point of intended resection.
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Real-time surgical trajectory
Confirms the planned corridor against updated anatomy after brain shift.
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Response to resection extent
Correlates what has been removed with the pre-operative target volume.
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Ventricular anatomy (for shunting)
Shows ventricular size and position — useful for shunt or ETV planning.
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Vascular structures at risk
Highlights arteries and veins adjacent to the resection cavity.
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Neuronavigation update
Refreshes the navigation dataset to correct for intra-operative brain shift.
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Immediate post-op assessment
Documents the resection cavity and any early complications before recovery.
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Red flag: intra-op haemorrhage or new stroke on iMRI — surgical revision
iMRI-detected bleeding or infarct triggers immediate surgical review within the same anaesthetic.
Next steps
What follows an iMRI-guided operation.
The imaging is only half the story — the plan that follows is where outcomes are made.
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Extended surgical resection based on iMRI
Residual tumour identified on iMRI is targeted within the same operation.
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Awake craniotomy integration
iMRI combined with awake mapping preserves eloquent language and motor cortex.
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Adjuvant chemoradiotherapy
Radiotherapy and temozolomide (or protocol-specific regimen) after high-grade glioma resection.
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Tumour MDT review
Histology and imaging returned to the neuro-oncology MDT to set the onward plan.
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Structured post-op imaging surveillance
Scheduled MRI at defined intervals to detect recurrence early.
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Rehabilitation input
Neuro-rehabilitation, physiotherapy, occupational therapy and speech and language therapy as needed.
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Genetic tumour analysis
Molecular profiling (IDH, MGMT, 1p/19q and others) to guide prognosis and treatment.
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Multi-disciplinary follow-up
Combined neurosurgery, oncology and endocrinology follow-up for pituitary cases.
Our vetted network
A short list of iMRI-equipped centres, we picked them.
Introductions are made privately once we understand your case and the MDT plan.
Selection criteria
How we choose every centre in our network.
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Consultant neurosurgeons in tertiary centres with integrated iMRI theatres
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MR-conditional anaesthetic and surgical equipment
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Neuro-oncology, pituitary and epilepsy MDT-linked planning
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Onward oncology, endocrinology and rehabilitation pathway
Red flags and safety
What the team watches for.
iMRI is safe in an MR-conditional theatre — the risks that matter are the ones the team screens for actively, before, during and after.
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Intra-op haemorrhage
Bleeding identified on iMRI is addressed immediately within the same anaesthetic.
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New stroke on iMRI
A new infarct on intra-op imaging triggers urgent vascular and surgical review.
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Ferromagnetic contamination
Any non-MR-safe item near the scanner is a hard stop — strict theatre checklists prevent it.
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Anaesthetic complication
GA in an MR-conditional theatre carries the usual anaesthetic risks, managed by the neuroanaesthetic team.
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Extended surgical time complications
Longer operations increase risks of pressure injury, DVT and infection — mitigated by protocols.
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Post-op infection
Wound or CNS infection is uncommon but monitored actively in the first weeks.
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Post-op seizure
New seizures after craniotomy are managed with anticonvulsants and neurology review.
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Residual tumour requiring re-do
Rarely, residual disease is only clear after final histology and needs a further operation.
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Post-op CSF leak
CSF leak — particularly after pituitary surgery — needs prompt neurosurgical review.
Reading your report
An iMRI report can look intimidating. It isn’t.
Whatever the finding, the report keeps to the same four parts.
A quiet reminder
The report is written for your surgical team, not for you — and that’s normal.
If you would like us to talk you through it before your follow-up, just ask.
- 01 Header
Indication and pre-operative diagnosis
Your details, the pre-op diagnosis, and the resection goal set by the MDT.
- 02 Technique
Scanner, sequences and neuronavigation
Field strength, sequences acquired intra-operatively, and how they were fused with navigation.
- 03 Findings
Resection cavity, residual disease, complications
Description of what was removed, any residual tumour, and any intra-op complications seen.
- 04 Impression
The conclusion: read this first
Whether the intended resection was achieved, and the immediate onward plan — read this first.
Sources and guidelines
- Society of British Neurological Surgeons
- European Association of Neurosurgical Societies
- Congress of Neurological Surgeons
- Royal College of Radiologists
Reviewed by Pulse Atlas Editorial Board, . Last reviewed 2026-07-30; next review 2027-07-30.
Frequently asked
Everything we get asked about intraoperative MRI.
Quick answers on what iMRI is, who benefits, safety, and where to find it in the UK.
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What is intraoperative MRI (iMRI)?
Intraoperative MRI is a high-field MRI scanner integrated into the neurosurgical operating theatre. It lets the surgical team image the brain during surgery, without moving you, so residual tumour can be identified and safely removed within the same anaesthetic.
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Which operations benefit most from iMRI?
The clearest evidence is in glioma resection, transsphenoidal pituitary surgery and selected epilepsy surgery. It is also useful for shunt and deep-brain-stimulation trajectory verification in specialist centres.
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Does iMRI reduce the need for a second operation?
Yes — for glioma in particular, iMRI increases the proportion of tumour removed at the first operation and reduces early re-operation rates. The exact benefit depends on tumour location, grade and eloquence of adjacent brain.
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Is iMRI safe?
Yes, in an MR-conditional theatre with MR-safe anaesthetic and surgical equipment. Strict checklists prevent ferromagnetic items entering the 5-gauss line. The additional imaging step adds theatre time but not meaningful additional risk.
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Do all UK neurosurgical centres have iMRI?
No. iMRI is standard in a small number of specialist tertiary centres. We route your case to a centre with an integrated iMRI theatre when it is the right test for your operation.
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When should I go to A&E instead of waiting for a private review?
Any sudden severe headache, seizure, one-sided weakness, slurred speech, or new visual loss is a 999 call. Do not wait for a private appointment — call 999 or attend A&E immediately.
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In practice, in London
Why private intraoperative magnetic resonance imaging moves differently in London
With intraoperative magnetic resonance imaging, the London question is usually about report turnaround and the radiologist reading it — not whether the scan is available. The wait for intraoperative magnetic resonance imaging on the NHS depends heavily on where you live and how urgently the referral is graded. Central and West London private clinics can normally book within a week, with imaging or a procedure slot to follow shortly after. It’s worth being honest about the reason for going private: usually it’s time, not a fundamentally different test.
In practice, a private intraoperative magnetic resonance imaging appointment in London means a named consultant, a proper hour in the room (or the equivalent on a video call), and a report you can actually read. Most of the imaging suites and endoscopy units we use sit within a mile of Harley Street or in Chelsea and Fulham, and turnaround on findings is measured in days, not weeks. For intraoperative magnetic resonance imaging specifically, the difference between a routine report and a sub-speciality read is where private care earns its keep.
There are a lot of consultants in London who can technically handle intraoperative magnetic resonance imaging. Fewer who do it week in, week out for the exact question you’re bringing. We spend most of our time working out which is which — and being straight when a different test or a different specialist would serve you better. Everything runs to CQC, GMC and Royal College standards; the choice is about fit, not floor.
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