3T Intraoperative MRI for Management of Pediatric CNS Neoplasms

Choudhri, Asim F.; Klimo, Paul; Auschwitz, Tyler S.; Whitehead, Matthew T.; Boop, Frederick A.

doi:10.3174/ajnr.a4040

Cited by 56 publications

(40 citation statements)

References 28 publications

(27 reference statements)

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“…In the larger studies (> 30 patients) with high-field magnets, the initial intention to treat was achieved in 70%-90% of all patients. 2,15,16 These numbers go along with our results concerning patients with a preoperatively intended CR and an intraoperatively confirmed and assumed CR, with achievement of this goal in 71% and 81% of patients, respectively. Although direct comparison is difficult because of the mixed pathologies in all of the other studies and only low-grade tumors in our analysis, our data appear comparable and therefore suggest that they are representative for pediatric iMRI surgery in general.…”

Section: Intraoperative Mri-guided Brain Tumor Surgery In Childrenmentioning

confidence: 95%

“…Four low-field 4,9,12,13 and 6 high-field 2,3,6,7,15,16 iMRI studies exist and generally report that it is safe to use iMRI in pediatric patients. No serious ferromagnetic accidents were reported, nor were more wound infections or anesthesia complications due to extended surgery times, which mirrors our experience.…”

Section: Intraoperative Mri-guided Brain Tumor Surgery In Childrenmentioning

confidence: 99%

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Beneficial impact of high-field intraoperative magnetic resonance imaging on the efficacy of pediatric low-grade glioma surgery

Röder¹,

Breitkopf²,

MS³

et al. 2016

FOC

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OBJECTIVE Intraoperative MRI (iMRI) is assumed to safely improve the extent of resection (EOR) in patients with gliomas. This study focuses on advantages of this imaging technology in elective low-grade glioma (LGG) surgery in pediatric patients. METHODS The surgical results of conventional and 1.5-T iMRI-guided elective LGG surgery in pediatric patients were retrospectively compared. Tumor volumes, general clinical data, EOR according to reference radiology assessment, and progression-free survival (PFS) were analyzed. RESULTS Sixty-five patients were included in the study, of whom 34 had undergone conventional surgery before the iMRI unit opened (pre-iMRI period) and 31 had undergone surgery with iMRI guidance (iMRI period). Perioperative data were comparable between the 2 cohorts, apart from larger preoperative tumor volumes in the pre-iMRI period, a difference without statistical significance, and (as expected) significantly longer surgeries in the iMRI group. According to 3-month postoperative MRI studies, an intended complete resection (CR) was achieved in 41% (12 of 29) of the patients in the pre-iMRI period and in 71% (17 of 24) of those in the iMRI period (p = 0.05). Of those cases in which the surgeon was postoperatively convinced that he had successfully achieved CR, this proved to be true in only 50% of cases in the pre-iMRI period but in 81% of cases in the iMRI period (p = 0.055). Residual tumor volumes on 3-month postoperative MRI were significantly smaller in the iMRI cohort (p < 0.03). By continuing the resection of residual tumor after the intraoperative scan (when the surgeon assumed that he had achieved CR), the rate of CR was increased from 30% at the time of the scan to 85% at the 3-month postoperative MRI. The mean follow-up for the entire study cohort was 36.9 months (3–79 months). Progression-free survival after surgery was noticeably better for the entire iMRI cohort and in iMRI patients with postoperatively assumed CR, but did not quite reach statistical significance. Moreover, PFS was highly significantly better in patients with CRs than in those with incomplete resections (p < 0.001). CONCLUSIONS Significantly better surgical results (CR) and PFS were achieved after using iMRI in patients in whom total resections were intended. Therefore, the use of high-field iMRI is strongly recommended for electively planned LGG resections in pediatric patients.

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Section: Intraoperative Mri-guided Brain Tumor Surgery In Childrenmentioning

confidence: 95%

Section: Intraoperative Mri-guided Brain Tumor Surgery In Childrenmentioning

confidence: 99%

Beneficial impact of high-field intraoperative magnetic resonance imaging on the efficacy of pediatric low-grade glioma surgery

Röder¹,

Breitkopf²,

MS³

et al. 2016

FOC

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“…There is limited evidence for the use of ioMRI in the paediatric population, and we have previously demonstrated that ioMRI has increased the rate of complete resections, with intraoperative surgical strategy being modified in 30% of procedures in our series of 40 cranial tumours [3,4,37]. Other groups have also demonstrated a modified surgical strategy ranging from 21% to 60% [8,14,[20][21]27]. Although the clinical effectiveness of ioMRI has been demonstrated for total tumour resection [4,31], a role for ioMRI has yet to be demonstrated in partial and subtotal tumour resection.…”

Section: Introductionmentioning

confidence: 77%

The role of early intra-operative MRI in partial resection of optic pathway/hypothalamic gliomas in children

et al. 2015

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“…27 With advancements in neuroimaging (e.g., tractography), and intraoperative technology (e.g., ultrasound, neurophysiological monitoring, and MRI), resection of CMTs is feasible in many cases. [10][11][12]23,35,39 Because most CMTs are low grade, they tend to grow circumferentially around pial structures and are redirected at interfaces with white matter tracts. Thus, the medial lemniscus and pyramidal decussating fibers halt their spread into the pontomedullary junction and direct their growth toward the fourth ventricle.…”

Section: 2332mentioning

confidence: 99%

Cervicomedullary tumors in children

McAbee

Modica

Thompson

et al. 2015

PED

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OBJECT Cervicomedullary tumors (CMTs) represent a heterogeneous group of intrinsic neoplasms that are typically low grade and generally carry a good prognosis. This single-institution study was undertaken to document the outcomes and current treatment philosophy for these challenging neoplasms. METHODS The charts of all pediatric patients with CMTs who received treatment at St. Jude Children’s Research Hospital between January 1988 and May 2013 were retrospectively reviewed. Demographic, surgical, clinical, radiological, pathological, and survival data were collected. Treatment-free survival and overall survival were estimated, and predictors of recurrence were analyzed. RESULTS Thirty-one children (16 boys, 15 girls) with at least 12 months of follow-up data were identified. The median age at diagnosis was 6 years (range 7 months-17 years) and the median follow-up was 4.3 years. Low-grade tumors (Grade I or II) were present in 26 (84%) patients. Thirty patients underwent either a biopsy alone or resection, with the majority of patients undergoing biopsy only (n = 12, 39%) or subtotal resection (n = 14, 45%). Only 4 patients were treated solely with resection; 21 patients received radiotherapy alone or in combination with other treatments. Recurrent tumor developed in 14 children (45%) and 4 died as a result of their malignancy. A high-grade pathological type was the only independent variable that predicted recurrence. The 5- and 10-year treatment-free survival estimates are 64.7% and 45.3%, respectively. The 5- and 10-year overall survival estimate is 86.7%. CONCLUSIONS Children with CMTs typically have low-grade neoplasms and consequently long-term survival, but high risk of recurrence. Therapy should be directed at achieving local tumor control while preserving and even restoring neurological function.

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3T Intraoperative MRI for Management of Pediatric CNS Neoplasms

Cited by 56 publications

References 28 publications

Beneficial impact of high-field intraoperative magnetic resonance imaging on the efficacy of pediatric low-grade glioma surgery

Beneficial impact of high-field intraoperative magnetic resonance imaging on the efficacy of pediatric low-grade glioma surgery

The role of early intra-operative MRI in partial resection of optic pathway/hypothalamic gliomas in children

Cervicomedullary tumors in children

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