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Published on: July 5, 2021
End-of-surgery MRI following pediatric neuro-oncological tumor resection
Timothy Mueller1, Eike Immo Piechowiak2, Jonathan Wermelinger1
1Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Purpose:
Magnetic resonance imaging (MRI) is routinely used to assess extent of resection after pediatric brain and spine tumor surgery and is commonly performed intraoperatively (ioMRI) or postoperatively (postopMRI). This study describes the implementation, feasibility, and workflow characteristics of end-of-surgery MRI (eosMRI), performed after wound closure but before termination of general anesthesia within a single-center pediatric neurosurgical practice and reports procedural and patient-related parameters observed over a 10-year period.
Methods:
We conducted a retrospective, single-center observational study including all pediatric brain and spine tumor surgeries performed with eosMRI, ioMRI, or postopMRI between July 2013 and September 2022. MRI modality selection followed institutional workflow patterns and surgeon judgment rather than predefined allocation criteria. Recorded variables included anesthesia time, surgery duration, imaging duration, patient age, tumor location, imaging-guided additional resection, and extent of resection (EOR).
Results:
A total of 129 surgeries in 106 children (mean age 9 years, range 0.3-18) were analyzed: 45 eosMRI (35%), 16 ioMRI (12%), and 68 postopMRI (53%). Within this workflow, eosMRI and ioMRI were associated with longer anesthesia times compared to postopMRI, whereas total surgery time was prolonged only in the ioMRI group. Imaging duration did not differ significantly across modalities. Patients managed with eosMRI were younger and more frequently had infratentorial tumors, reflecting institutional selection patterns. Extent of resection (EOR) distribution did not differ statistically between modalities.
Conclusion:
This retrospective single-center experience demonstrates the feasibility of eosMRI within a pediatric neurosurgical workflow, particularly regarding operative logistics and anesthesia exposure. These descriptive findings may inform perioperative imaging considerations in comparable institutional settings for pediatric neuro-oncological surgery.
Insights
End-of-surgery MRI (eosMRI) is a feasible option for pediatric neurosurgery, offering similar extent of resection outcomes to intraoperative (ioMRI) and postoperative (postopMRI) scans. This approach integrates well into surgical workflows with manageable anesthesia exposure.
Area of Science:
- Pediatric neurosurgery
- Neuroradiology
- Surgical oncology
Background:
- Magnetic resonance imaging (MRI) is crucial for assessing tumor resection in pediatric neurosurgery.
- Intraoperative MRI (ioMRI) and postoperative MRI (postopMRI) are common modalities.
- End-of-surgery MRI (eosMRI) offers an alternative timing for imaging.
Purpose of the Study:
- To evaluate the implementation, feasibility, and workflow of end-of-surgery MRI (eosMRI) in pediatric neurosurgery.
- To analyze procedural and patient parameters over a 10-year period.
- To compare eosMRI with intraoperative MRI (ioMRI) and postoperative MRI (postopMRI).
Main Methods:
- Retrospective, single-center observational study.
- Analysis of 129 pediatric brain and spine tumor surgeries (July 2013-September 2022).
- Comparison of eosMRI, ioMRI, and postopMRI based on anesthesia time, surgery duration, imaging duration, patient age, tumor location, and extent of resection (EOR).
Main Results:
- 45 eosMRI, 16 ioMRI, and 68 postopMRI cases were analyzed.
- eosMRI and ioMRI showed longer anesthesia times than postopMRI; only ioMRI prolonged total surgery time.
- No significant difference in extent of resection (EOR) distribution across modalities.
- eosMRI patients were younger with more infratentorial tumors.
Conclusions:
- End-of-surgery MRI (eosMRI) is feasible within pediatric neurosurgical workflows.
- eosMRI demonstrates comparable extent of resection to other MRI modalities.
- Findings can inform perioperative imaging strategies in pediatric neuro-oncology.
