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Hyperacute Infarct on Intraoperative Diffusion Imaging of Pediatric Brain Tumor Surgery

Christine Saint-Martin1, Sergio Apuzzo2, Ayat Salman2

  • 1Division of Pediatric Medical Imaging, Department of Diagnostic Radiology, The Montreal Children's Hospital, McGill University Health Center, Montreal, Quebec, Canada.

The Canadian Journal of Neurological Sciences. Le Journal Canadien Des Sciences Neurologiques
|June 11, 2019
PubMed
Abstract

Insights

Hyperacute infarcts complicate pediatric brain tumor resections, with vessel encasement being a key risk factor. Intraoperative MRI may underestimate the final extent of these brain infarcts.

Area of Science:

  • Pediatric neuro-oncology
  • Neuroradiology
  • Cerebrovascular complications

Background:

  • Brain neoplasms are a leading childhood cancer, with surgical resection as the primary treatment.
  • Intraoperative MRI aids in optimizing brain tumor resection.
  • The ability of intraoperative MRI to detect hyperacute ischemic infarcts is not well-established.

Purpose of the Study:

  • To evaluate the incidence of hyperacute arterial infarcts during pediatric brain tumor resection.
  • To identify risk factors associated with these infarcts.
  • To assess the utility of intraoperative MRI in detecting and characterizing infarcts.

Main Methods:

  • Retrospective analysis of pre- and intraoperative MRIs (including DWI) in 115 pediatric brain tumor resections.
  • Correlation with early and 3-month postoperative MRIs.
  • Analysis of patient demographics, tumor pathology, location, resection type, and vessel encasement.

Main Results:

  • 11% (13/115) of cases developed hyperacute arterial ischemic infarcts.
  • Tumoral vessel encasement was significantly more frequent in the infarct group (69% vs. 25.5%).
  • Intraoperative DWI underestimated the final infarct extent compared to early postoperative MRI.

Conclusions:

  • Hyperacute infarcts are a notable complication of pediatric brain tumor resection.
  • Tumoral encasement of the circle of Willis vessels is a primary risk factor.
  • Intraoperative DWI may not fully capture the extent of infarction detected on early postoperative imaging.
Keywords:
Hyperacute arterial infarctIntraoperative Diffusion-Weighted Imaging (ioDWI)Intraoperative Magnetic Resonance Imaging (ioMRI)

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