Intraoperative 3-Tesla MRI in the management of paediatric cranial tumours—initial experience

Avula, Shivaram; Mallucci, Conor; Pizer, Barry; Garlick, Deborah; Crooks, Daniel; Abernethy, Laurence

doi:10.1007/s00247-011-2261-6

Cited by 25 publications

(15 citation statements)

References 16 publications

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“…1,3,49 This new tool, used in our institution since 2010, may facilitate safer tumor removal and help to reduce the need for second-look operations for unexpected tumor residuum-achieving the goals of surgery more safely. This, of course, needs to be evaluated in a prospective study, which has been commenced in our institution and will be reported on in the future.…”

Section: Neurosurgical Advancesmentioning

confidence: 99%

The role of surgery in optic pathway/hypothalamic gliomas in children

Goodden¹,

Pizer

Pettorini³

et al. 2014

PED

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106

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Object Optic pathway/hypothalamic gliomas (OPHGs) are generally benign tumors situated in an exquisitely sensitive brain region. The location and natural history of OPHGs has led to much debate about optimal treatment. This paper revisits the role of and optimal timing of debulking surgery in OPHG. Methods This paper presents a series of cases managed by the neuro-oncology team at Alder Hey Children's Hospital and a single surgeon. Data were collected retrospectively for periods prior to 2009 and prospectively thereafter. Tailored treatment strategies were used, including observation and combinations of surgery, chemotherapy, and radiotherapy. Tumor control rates and outcomes are reviewed. Results Forty-two patients were treated between 1998 and 2011. Their median age at diagnosis was 5 years 7 months. Nineteen patients were positive for neurofibromatosis Type 1 (NF1) and 23 patients were negative for NF1. The median duration of follow-up was 77 months (range 21.8–142.3 months). Presenting symptoms included visual impairment (in 50% of cases), headache (in 24%), and hypothalamic/pituitary dysfunction (in 29%). Twenty-two debulking procedures were performed in 21 patients. Four biopsies (3 open, 1 endoscopic) were also performed. The histological diagnosis was pilocytic astrocytoma in 21 patients and pilomyxoid astrocytoma in 2 patients. Ten patients (Group 1) had primary surgical debulking alone and were then observed. Four patients (Group 2) had surgical debulking, plus planned chemotherapy within 3 months. Seven patients (Group 3) required surgical debulking for progressive disease following a variety of treatments. Patient age had the greatest impact on subsequent tumor progression. In total, 13 patients received chemotherapy, 4 on initial presentation, 4 in combination with surgery, and 5 for further tumor progression. Five patients were treated with radiotherapy, 3 prior to referral to Alder Hey. Eleven patients required shunt insertion for hydrocephalus. Vision was stabilized for 74% of patients. The number of patients with hypothalamic/pituitary dysfunction increased from 12 at presentation to 16 by the end of treatment. The overall survival rate was 93%. Three patients died—1 from tumor progression, 1 from infective complications from tumor biopsy, and 1 from a spontaneous posterior fossa hemorrhage. NF1 was associated with improved outcome—fewer patients required active intervention and rates of visual impairment and/or or hypothalamic/pituitary dysfunction were lower. Conclusions Good long-term survival and functional outcomes can be achieved in children with OPHG. Tumor control was achieved through an individualized approach using surgery, chemotherapy, or radiotherapy in varied combinations. The authors aim to limit radiotherapy to cases involving older children in whom other therapies have failed, due to the well-described and often devastating late effects associated with midline cranial irradiation. Surgery has a clear role for diagnosis, tumor control, and relief of mass effect. In particular, primary surgical debulking of tumor (without adjuvant therapy) is safe and effective. Recent advances in intraoperative MRI may add value and need further assessment.

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Section: Neurosurgical Advancesmentioning

confidence: 99%

The role of surgery in optic pathway/hypothalamic gliomas in children

Goodden¹,

Pizer

Pettorini³

et al. 2014

PED

Self Cite

106

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“…[11][12][13][14] With respect to high-field-strength iMRI, typically defined as 1.5T or higher, its impact on operating room and anesthesia time and the incidence of MR imaging-related complications, particularly in the pediatric population, have been the topic of limited publications. 3,[15][16][17] We performed a retrospective review of our 24-month experience with a 3T-iMRI at a tertiary care children's hospital to determine the impact of this tool on surgical planning, workflow, and patient outcomes. Comparison was made with a cohort of pediatric patients with brain tumor at our institution from before installation of the iMRI scanner.…”

mentioning

confidence: 99%

3T Intraoperative MRI for Management of Pediatric CNS Neoplasms

Choudhri

Klimo

Auschwitz³

et al. 2014

AJNR Am J Neuroradiol

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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].…”

Section: Introductionmentioning

confidence: 80%

“…ioMRI allows surgical goals to be reassessed intraoperatively following primary resection and its safety and efficacy has been previously established in relation to total tumour resection in the adult and paediatric population [3].…”

Section: Discussionmentioning

confidence: 99%