Intraoperative magnetic resonance imaging in pediatric neurosurgery: safety and utility

Abstract

<jats:sec> <jats:title>OBJECTIVE</jats:title> <jats:p>The use of high-field intraoperative MRI has been largely studied for the treatment of intracranial tumors in adult patients. In this study, the authors investigated the safety, advantages, and limitations of high-field iMRI for cranial neurosurgical procedures in pediatric patients, with particular attention to craniopharyngiomas and gliomas.</jats:p></jats:sec> <jats:sec> <jats:title>METHODS</jats:title> <jats:p>The authors performed 82 surgical procedures in patients under 16 years of age (range 0.8–15 years) over an 8-year period (2007–2014) using iMRI. The population was divided into 3 groups based on the condition treated: sellar region tumors (Group 1), gliomas (Group 2), and other pathological entities (Group 3). The patients' pre- and postoperative neurological status, the presence of residual tumor, the number of intraoperative scans, and complications were evaluated.</jats:p></jats:sec> <jats:sec> <jats:title>RESULTS</jats:title> <jats:p>In Group 1, gross-total resection (GTR) was performed in 22 (88%) of the procedures and subtotal resection (STR) in 3 (12%). In Group 2, GTR, STR, and partial resection (PR) were performed, respectively, in 15 (56%), 7 (26%), and 5 (18%) of the procedures. In Group 3, GTR was performed in 28 (93%) and STR in 2 (7%) of the procedures. In cases of craniopharyngioma (Group 1) and glioma (Group 2) in which a complete removal was planned, iMRI allowed localization of residual lesions and attainment of the surgical goal through further resection, respectively, in 18% and 27% of the procedures. Moreover, in gliomas the resection could be extended from partial to subtotal in 50% of the cases. In 17% of the patients in Group 3, iMRI enabled the identification and further removal of tumor remnants. There was no intra- or postoperative complication related to the use of iMRI despite special technical difficulties in smaller children.</jats:p></jats:sec> <jats:sec> <jats:title>CONCLUSIONS</jats:title> <jats:p>In this study, the use of iMRI in children proved to be safe. It was most effective in increasing the extent of tumor resection, especially in patients with low-grade gliomas and craniopharyngiomas. The most prominent disadvantage of high-field iMRI was the limitation with respect to operative positioning due to the configuration of the surgical table.</jats:p></jats:sec>

Intraoperative MRI-guided Resection in Pediatric Brain Tumor Surgery: A Meta-analysis of Extent of Resection and Safety Outcomes

“…The mean number of scans per procedure was 1.15 (range: 1-4). 19,[21][22][23][24][25][26][27][28][29][30] The highest average number of scans per procedure (1.73) was observed in a series of 11 optic or hypothalamic gliomas treated by iMRIassisted surgeries. 21…”

“…Frequency of histopathologic entities treated by iMRI-guided resections was determined in 346 patients. 19,[21][22][23][24][25][26][27][28][29][30]…”

Safeness and Utility of Concomitant Intraoperative Monitoring with Intraoperative Magnetic Resonance Imaging in Children: A Pilot Study

“…The benefit of high-field intraoperative magnetic resonance imaging (ioMRI) in the treatment of intracranial lesions lead to its increased use [10]. The use of ioMRI can increase the extent of resection and can therefore contribute to improved overall survival rates [11][12][13] .Recent studies also corroborated the safeness of this technique in the pediatric population [11,13].…”

Multiplexed imaging for diagnosis and therapy

“…However, because of crosstalk between energy spectra and scatter, non-trivial correction methods must be applied, and the energy resolution of scanners is continuously sought to improve this outcome 166,167 . Despite this limitation, dual-tracer SPECT imaging is feasible using 201 Tl or 111 In in healthy volunteers and in diverse disease settings, and including brain imaging, cardiac imaging and cancer imaging 166,[168][169][170][171] . Improved scanner technology 172 and kinetic analysis also promulgate simultaneous dual-isotope imaging in PET, as demonstrated for single-scan dual-tracer (staggered injection of FDG and FLT; 120 min of scan time) studies in patients with primary brain tumours 173 .…”

“…Intraoperative MRI (iMRI) has significantly impacted neurosurgery, where the benefits of high resolution, up-to-the-minute images are apparent 194,[200][201][202][203] . The value of iMRI in glioma resection was demonstrated in a parallel-group trial, with complete tumour resection achieved in 96% of the 24 patients who received iMRI-assisted surgery compared with 68% of the 25-patient control group who received non-assisted surgery (p=0.023) in the randomised trial 203 .…”