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

Abstract

Background The objective of this meta-analysis was to analyze the impact of intraoperative magnetic resonance imaging (iMRI) on pediatric brain tumor surgery with regard to the frequency of histopathologic entities, additional resections secondary to iMRI, rate of gross total resections (GTR) in glioma surgery, extent of resection (EoR) in supra- and infratentorial compartment, surgical site infections (SSIs), and neurologic outcome after surgery. Methods MEDLINE/PubMed Service was searched for the terms “intraoperative MRI,” “pediatric,” “brain,” “tumor,” “glioma,” and “surgery.” The review produced 126 potential publications; 11 fulfilled the inclusion criteria, including 584 patients treated with iMRI-guided resections. Studies reporting about patients <18 years, setup of iMRI, surgical workflow, and extent of resection of iMRI-guided glioma resections were included. Results IMRI-guided surgery is mainly used for pediatric low-grade gliomas. The mean rate of GTR in low- and high-grade gliomas was 78.5% (207/254; 95% confidence interval [CI]: 64.6–89.7, p < 0.001). The mean rate of GTR in iMRI-assisted low-grade glioma surgery was 74.3% (35/47; 95% CI: 61.1–85.5, p = 0.759). The rate of SSI in surgery assisted by iMRI was 1.6% (6/482; 95% CI: 0.7–2.9). New onset of transient postoperative neurologic deficits were observed in 37 (33.0%) of 112 patients. Conclusion IMRI-guided surgery seems to improve the EoR in pediatric glioma surgery. The rate of SSI and the frequency of new neurologic deficits after IMRI-guided surgery are within the normal range of pediatric neuro-oncologic surgery.

Retrospective and integrative analyses of molecular characteristics and their specific imaging parameters in pediatric grade 1 gliomas

“…It is affording a specific focus on the non‐NF1 grade 1 PLGGs, where we confirmed that BRAF p.V600E had no impact on survival when tumors were completely resected. Therefore, similar to the more heterogeneous groups of grade 1 and 2 PLGGs that were published recently, our therapeutic management should tend in grade 1 to a near‐total resection using more and more intraoperative MRI to obtain a lower morbidity and have a safer outcome 33,34 . Our conclusions linking the presence of BRAF p.V600E in PLGGs or the worst patient outcome to a higher proportion of the solid components at MRI are leading to extend this surgical principle to all grade 1 PLGGs presenting a solid feature above 50% of the entire tumor at iMRI.…”

“…33,34 Our conclusions linking the presence of BRAF p.V600E in PLGGs or the worst patient outcome to a higher proportion of the solid components at MRI are leading to extend this surgical principle to all grade 1 PLGGs presenting a solid feature above 50% of the entire tumor at iMRI. Correlations between cystic and solid proportions and the responses Abbreviations : N/A informations not avaliable; CR complete response; PR, partial response; SD, stable disease; PD, progressive disease / * 2 patients did not have FLAIR sequences / ** one patient with an optic pathway glioma progressed with multiple lesions.…”

Intraoperative MR Imaging during Glioma Resection

“…228 Another significant aspect of the ioMR imaging procedure concerns a possible increase in surgical site infection because craniotomy patients need to be moved into unsterilized diagnostic MR scanner. We were able to identify only two reports dealing with this issue, where it was noted that the rate of surgical site infection and the frequency of new neurologic deficits after ioMR image-guided surgery were within the normal range of pediatric neuro-oncologic surgery, 229 as well as wide age ranged (1-84 years old) at the multi-theater type system. 62 Overall, ioMR imaging seems to have improved the safety and increased the amount of tumor resected in patients with glioma, but the certainty of the evidence is low.…”

Image-guided surgery and novel intraoperative devices for enhanced visualisation in general and paediatric surgery: a review

“…Wach et al., in their metanalysis, evaluated the impact of iMRI on surgery of paediatric brain tumours by analysing data on the frequency of histopathologic entities, additional resections secondary to iMRI, rate of gross total resections in glioma surgery, and neurologic outcome after surgery. Overall, iMRI-guided surgery seems to improve paediatric glioma surgery, with a frequency of new neurologic deficits after iMRI-guided surgery within the normal range of paediatric neuro-oncologic surgery [ 73 ]. About brain tumour resection, Avula et al.…”