Abstract
IntroductionWe analyze our preliminary experience using the PoleStar N20 mobile intraoperative MR (iMR) system as an adjunct for pediatric brain tumor resection.MethodsWe analyzed 11 resections in nine children between 1 month and 17 years old. After resection, we acquired iMR scans to detect residual tumor and update neuronavigation. We compared final iMR interpretation by the neurosurgeon with early postoperative MR interpretation by a neuroradiologist.ResultsPatient positioning was straightforward, and image quality (T1 7-min 4-mm sequences) sufficient in all cases. In five cases, contrast enhancement suspect for residual tumor was noted on initial postresection iMR images. In one case, a slight discrepancy with postoperative imaging after 3 months was no longer visible after 1 year. No serious perioperative adverse events related to the PoleStar N20 were encountered, except for transient shoulder pain in two.ConclusionsUsing the PoleStar N20 iMR system is technically feasible and safe for both supra- and infratentorial tumor resections in children of all ages. Their small head and shoulders favor positioning in the magnet bore and allow the field of view to cover more than the area of primary interest, e.g., the ventricles in an infratentorial case. Standard surgical equipment may be used without significant limitations. In this series, the use of iMR leads to an increased extent of tumor resection in 45 % of cases. Correlation between iMR and early postoperative MR is excellent, provided image quality is optimal and interpretation is carefully done by someone sufficiently familiar with the system.
Highlights
We analyze our preliminary experience using the PoleStar N20 mobile intraoperative MR system as an adjunct for pediatric brain tumor resection
The use of intraoperative MR (iMR) leads to an increased extent of tumor resection in 45 % of cases
We report our preliminary experience with the low-field strength PoleStar N20 mobile iMR system, focusing on the feasibility of this particular equipment, whether its use had direct intraoperative consequences and whether postresection low-field strength iMR images were in accordance with early postoperative high-field strength MR images
Summary
We analyze our preliminary experience using the PoleStar N20 mobile intraoperative MR (iMR) system as an adjunct for pediatric brain tumor resection. Image-guided surgery can certainly help to achieve this goal [2], with preoperative images used for surgical planning and navigation These images become progressively inaccurate during the course of surgery because of brain shift following loss of cerebrospinal fluid, resection of pathological tissue, and development of edema. This is exactly where intraoperative MRI (iMRI) may be of use: to demonstrate residual tumor and to update images for navigation [1, 3,4,5,6,7,8, 11, 13, 15, 20, 21, 24]
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