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Surg Neurol Int. 2012;3(Suppl 2):S65-72. doi: 10.4103/2152-7806.95417. Epub 2012 Apr 26.

Importance of intraoperative magnetic resonance imaging for pediatric brain tumor surgery.

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1
Department of Neurosurgery, Alder Hey Children's NHS Foundation Trust, Liverpool, United Kingdom.

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.

KEYWORDS:

Magnetic resonance imaging; neuronavigation; pediatric brain tumor

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