Abstract
Background:High-field intraoperative MRI (IoMRI) is gaining increasing recognition as an invaluable tool in pediatric brain tumor surgery where the extent of tumor resection is a major prognostic factor. We report the initial experience of a dedicated pediatric 3-T intraoperative MRI (IoMRI) unit with integrated neuronavigation in the management of pediatric brain tumors.Methods:Seventy-three children (mean age 9.5 years; range 0.2–19 years) underwent IoMRI between October 2009 and January 2012, during 79 brain tumor resections using a 3-T MR scanner located adjacent to the neurosurgical operating theater that is equipped with neuronavigation facility. IoMRI was performed either to assess the extent of tumor resection after surgical impression of complete/intended tumor resection or to update neuronavigation. The surgical aims, IoMRI findings, extent of tumor resection, and follow-up data were reviewed.Results:Complete resection was intended in 47/79 (59%) operations. IoMRI confirmed complete resection in 27/47 (57%). IoMRI findings led to further resection in 12/47 (26%). In 7/47 (15%), IoMRI was equivocal for residual tumor and no evidence of residual tumor was found on re-inspection. In 32/79 (41%) operations, the surgical aim was partial tumor resection. In this subset, surgical resection was extended following IoMRI in 13/32 (41%) operations. None of the patients required early second look procedure for residual disease.Conclusions:At our institution, IoMRI has led to increased rate of tumor resection and a change in surgical strategy with further tumor resection in 32% of patients. While interpreting IoMRI, it is important to be aware of the known pitfalls.
Highlights
High-field intraoperative MRI (IoMRI) is gaining increasing recognition as an invaluable tool in pediatric brain tumor surgery where the extent of tumor resection is a major prognostic factor
Surgery is a vital part of management, and the degree of primary surgical resection is a major prognostic factor in several tumor types, including the more common malignant tumors such as medulloblastoma, high-grade glioma, and ependymoma.[1,8,10]
IoMRI was used during 79 cranial tumor resections in 73 children
Summary
Seventy-three children (mean age 9.5 years; range 0.2–19 years) underwent IoMRI between October 2009 and January 2012, during 79 brain tumor resections using a 3-T MR scanner located adjacent to the neurosurgical operating theater that is equipped with neuronavigation facility. IoMRI was performed either to assess the extent of tumor resection after surgical impression of complete/intended tumor resection or to update neuronavigation. Between October 2009 and January 2012, IoMRI was performed on 73 patients during 79 cranial tumor resections. Fluid and drug infusion pumps should be MRI compatible All non–MRI-compatible material including conventional ECG electrodes, temperature probes, and diathermy plates must be removed before transfer into the MRI scanner Imaging. IoMRI was performed on a Philips Achieva 3-T scanner (http://www.healthcare.philips.com) located alongside the neurosurgical operation theater and equipped with neuronavigation facility using BrainSUITE® (BrainLAB, Feldkirchen, Germany; http://www.brainlab.com). Preoperative imaging was performed either on the 3-T scanner or a Philips Achieva 1.5-T scanner
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