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Role of Diffusion MRI Tractography in Endoscopic Endonasal Skull Base Surgery
Published on: July 5, 2021
3T intraoperative MRI for management of pediatric CNS neoplasms
A F Choudhri1, P Klimo2, T S Auschwitz3
1From the Departments of Radiology (A.F.C., M.T.W.) Neurosurgery (A.F.C., P.K., T.S.A., F.A.B.) Ophthalmology (A.F.C.), University of Tennessee Health Science Center, Memphis, Tennessee Le Bonheur Neuroscience Institute (A.F.C., P.K., M.T.W., F.A.B.), Le Bonheur Children's Hospital, Memphis, Tennessee achoudhri@uthsc.edu.
Background And Purpose:
High-field-strength intraoperative MR imaging has emerged as a powerful adjunct for resection of brain tumors. However, its exact role has not been firmly established. We sought to determine the impact of 3T-intraoperative MRI on the surgical management of childhood CNS tumors.
Materials And Methods:
We evaluated patient data from a single academic children's hospital during a consecutive 24-month period after installation of a 3T-intraoperative MRI. Tumor location, histology, surgical approach, operating room time, presence and volume of residual tumor, need for tumor and non-tumor-related reoperation, and anesthesia- and MR imaging-related complications were evaluated. Comparison with pre-intraoperative MRI controls was performed.
Results:
One hundred ninety-four patients underwent intraoperative MRI-guided surgery. Of these, 168 were 18 years or younger (mean, 8.9 ± 5.0 years; 108 males/60 females). There were 65 posterior fossa tumors. The most common tumors were pilocytic astrocytoma (n = 31, 19%), low-grade glioma (n = 31, 19%), and medulloblastoma (n = 20, 12%). An average of 1.2 scanning sessions was performed per patient (maximum, 3). There were no MR imaging-related safety issues. Additional tumor was resected after scanning in 21% of patients. Among patients with a preoperative goal of gross total resection, 93% achieved this goal. The 30-day reoperation rate was <1% (n = 1), and no patient required additional postoperative MR imaging during the same hospital stay.
Conclusions:
Intraoperative MRI is safe and increases the likelihood of gross total resection, albeit with increased operating room time, and reduces the need for early reoperation or repeat sedation for postoperative scans in children with brain tumors.
Insights
Intraoperative MRI in pediatric brain tumor surgery is safe and effective, increasing gross total resection rates. This advanced imaging reduces the need for repeat surgeries and postoperative scans in children.
Area of Science:
- Pediatric Neurosurgery
- Neuroradiology
- Oncology
Background:
- High-field-strength intraoperative MRI (iMRI) is a valuable tool for brain tumor resection.
- Its precise impact on pediatric central nervous system (CNS) tumor management requires further elucidation.
Purpose of the Study:
- To assess the effect of 3 Tesla (3T) intraoperative MRI on the surgical management of pediatric CNS tumors.
Main Methods:
- A retrospective analysis of 194 pediatric patients undergoing iMRI-guided surgery over 24 months.
- Data included tumor characteristics, surgical approach, operating room time, residual tumor volume, reoperation rates, and complications.
- Comparison was made with pre-iMRI control cases.
Main Results:
- 93% of patients with a goal of gross total resection achieved it.
- 21% of patients had additional tumor resected after iMRI.
- No MR imaging-related safety issues occurred, and the 30-day reoperation rate was less than 1%.
Conclusions:
- Intraoperative MRI is safe for pediatric brain tumor surgery.
- It enhances the likelihood of achieving gross total resection.
- It reduces the need for early reoperation and repeat sedation for postoperative scans, despite increased operating room time.
