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Velagapudi V, Artz NS, Fite JK, Chan SS, Rouse AG. Low-Field Portable MR Imaging to Evaluate Ventricular Volumes: A Single-Center Retrospective Study. AJNR Am J Neuroradiol 2024; 45:1076-1080. [PMID: 38964865 PMCID: PMC11383396 DOI: 10.3174/ajnr.a8269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 02/23/2024] [Indexed: 07/06/2024]
Abstract
This study assesses the efficacy of low-field portable MR imaging in measuring ventricular volumes in the pediatric population in the hospital setting. We compared portable and standard of care MR images from the same patient. The estimated ventricular volumes had excellent agreement with a mean bias of 2.06% by Bland-Altman analysis and a correlation of 0.99. From this initial data set, our results suggest that low-field, portable MR imaging is a promising technique for imaging and quantifying ventricular volumes.
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Affiliation(s)
- Vivek Velagapudi
- From the School of Medicine (V.V.), University of Kansas Medical Center, Kansas City, Kansas
| | - Nathan S Artz
- Department of Radiology (N.S.A., J.K.F., S.S.C.), University of Missouri at Kansas City School of Medicine, Kansas City, Missouri
- Department of Radiology (N.S.A., J.K.F., S.S.C.), Children's Mercy Kansas City, Kansas City, Missouri
| | - Johnston K Fite
- Department of Radiology (N.S.A., J.K.F., S.S.C.), University of Missouri at Kansas City School of Medicine, Kansas City, Missouri
- Department of Radiology (N.S.A., J.K.F., S.S.C.), Children's Mercy Kansas City, Kansas City, Missouri
| | - Sherwin S Chan
- Department of Radiology (N.S.A., J.K.F., S.S.C.), University of Missouri at Kansas City School of Medicine, Kansas City, Missouri
- Department of Radiology (N.S.A., J.K.F., S.S.C.), Children's Mercy Kansas City, Kansas City, Missouri
| | - Adam G Rouse
- Department of Neurosurgery (A.R.), Department of Neurosurgery (A.G.R.), University of Kansas Health System, Kansas City, Kansas
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Becerra V, Hinojosa J, Candela S, Culebras D, Alamar M, Armero G, Echaniz G, Artés D, Munuera J, Muchart J. The impact of 1.5-T intraoperative magnetic resonance imaging in pediatric tumor surgery: Safety, utility, and challenges. Front Oncol 2023; 12:1021335. [PMID: 36686826 PMCID: PMC9846736 DOI: 10.3389/fonc.2022.1021335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 12/05/2022] [Indexed: 01/06/2023] Open
Abstract
Objective In this study, we present our experience with 1.5-T high-field intraoperative magnetic resonance imaging (ioMRI) for different neuro-oncological procedures in a pediatric population, and we discuss the safety, utility, and challenges of this intraoperative imaging technology. Methods A pediatric consecutive-case series of neuro-oncological surgeries performed between February 2020 and May 2022 was analyzed from a prospective ioMRI registry. Patients were divided into four groups according to the surgical procedure: intracranial tumors (group 1), intraspinal tumors (group 2), stereotactic biopsy for unresectable tumors (group 3), and catheter placement for cystic tumors (group 4). The goal of surgery, the volume of residual tumor, preoperative and discharge neurological status, and postoperative complications related to ioMRI were evaluated. Results A total of 146 procedures with ioMRI were performed during this period. Of these, 62 were oncology surgeries: 45 in group 1, two in group 2, 10 in group 3, and five in group 4. The mean age of our patients was 8.91 years, with the youngest being 12 months. ioMRI identified residual tumors and prompted further resection in 14% of the cases. The mean time for intraoperative image processing was 54 ± 6 min. There were no intra- or postoperative security incidents related to the use of ioMRI. The reoperation rate in the early postoperative period was 0%. Conclusion ioMRI in pediatric neuro-oncology surgery is a safe and reliable tool. Its routine use maximized the extent of tumor resection and did not result in increased neurological deficits or complications in our series. The main limitations included the need for strict safety protocols in a highly complex surgical environment as well as the inherent limitations on certain patient positions with available MR-compatible headrests.
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Affiliation(s)
- Victoria Becerra
- Department of Neurosurgery, Hospital Sant Joan de Déu, Esplugues de Llobregat (Cataluña), Spain,*Correspondence: Victoria Becerra,
| | - José Hinojosa
- Department of Neurosurgery, Hospital Sant Joan de Déu, Esplugues de Llobregat (Cataluña), Spain
| | - Santiago Candela
- Department of Neurosurgery, Hospital Sant Joan de Déu, Esplugues de Llobregat (Cataluña), Spain
| | - Diego Culebras
- Department of Neurosurgery, Hospital Sant Joan de Déu, Esplugues de Llobregat (Cataluña), Spain
| | - Mariana Alamar
- Department of Neurosurgery, Hospital Sant Joan de Déu, Esplugues de Llobregat (Cataluña), Spain
| | - Georgina Armero
- Department of Pediatrics, Hospital Sant Joan de Déu, Esplugues de Llobregat (Cataluña), Spain
| | - Gastón Echaniz
- Department of Anesthesiology, Hospital Sant Joan de Déu, Esplugues de Llobregat (Cataluña), Spain
| | - David Artés
- Department of Anesthesiology, Hospital Sant Joan de Déu, Esplugues de Llobregat (Cataluña), Spain
| | - Josep Munuera
- Diagnostic Imaging Department, Hospital Sant Joan de Déu, Esplugues de Llobregat (Cataluña), Spain,Diagnostic and Therapeutic Imaging, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat (Cataluña), Spain
| | - Jordi Muchart
- Diagnostic Imaging Department, Hospital Sant Joan de Déu, Esplugues de Llobregat (Cataluña), Spain,Diagnostic and Therapeutic Imaging, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat (Cataluña), Spain
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Wach J, Banat M, Borger V, Vatter H, Haberl H, Sarikaya-Seiwert S. Intraoperative MRI-guided Resection in Pediatric Brain Tumor Surgery: A Meta-analysis of Extent of Resection and Safety Outcomes. J Neurol Surg A Cent Eur Neurosurg 2020; 82:64-74. [PMID: 32968998 DOI: 10.1055/s-0040-1714413] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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.
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Affiliation(s)
- Johannes Wach
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
| | - Mohammad Banat
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
| | - Valeri Borger
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
| | - Hartmut Vatter
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
| | - Hannes Haberl
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
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Karsy M, Akbari SH, Limbrick D, Leuthardt EC, Evans J, Smyth MD, Strahle J, Leonard J, Cheshier S, Brockmeyer DL, Bollo RJ, Kestle JR, Honeycutt J, Donahue DJ, Roberts RA, Hansen DR, Riva-Cambrin J, Sutherland G, Gallagher C, Hader W, Starreveld Y, Hamilton M, Duhaime AC, Jensen RL, Chicoine MR. Evaluation of pediatric glioma outcomes using intraoperative MRI: a multicenter cohort study. J Neurooncol 2019; 143:271-280. [PMID: 30977059 DOI: 10.1007/s11060-019-03154-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 03/19/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND The use of intraoperative MRI (iMRI) during treatment of gliomas may increase extent of resection (EOR), decrease need for early reoperation, and increase progression-free and overall survival, but has not been fully validated, particularly in the pediatric population. OBJECTIVE To assess the accuracy of iMRI to identify residual tumor in pediatric patients with glioma and determine the effect of iMRI on decisions for resection, complication rates, and other outcomes. METHODS We retrospectively analyzed a multicenter database of pediatric patients (age ≤ 18 years) who underwent resection of pathologically confirmed gliomas. RESULTS We identified 314 patients (mean age 9.7 ± 4.6 years) with mean follow-up of 48.3 ± 33.6 months (range 0.03-182.07 months) who underwent surgery with iMRI. There were 201 (64.0%) WHO grade I tumors, 57 (18.2%) grade II, 24 (7.6%) grade III, 9 (2.9%) grade IV, and 23 (7.3%) not classified. Among 280 patients who underwent resection using iMRI, 131 (46.8%) had some residual tumor and underwent additional resection after the first iMRI. Of the 33 tissue specimens sent for pathological analysis after iMRI, 29 (87.9%) showed positive tumor pathology. Gross total resection was identified in 156 patients (55.7%), but this was limited by 69 (24.6%) patients with unknown EOR. CONCLUSIONS Analysis of the largest multicenter database of pediatric gliomas resected using iMRI demonstrated additional tumor resection in a substantial portion of cases. However, determining the impact of iMRI on EOR and outcomes remains challenging because iMRI use varies among providers nationally. Continued refinement of iMRI techniques for use in pediatric patients with glioma may improve outcomes.
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Affiliation(s)
- Michael Karsy
- Department of Neurosurgery, University of Utah, Salt Lake City, UT, USA
| | - S Hassan Akbari
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, MO, USA
| | - David Limbrick
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Eric C Leuthardt
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, MO, USA
| | - John Evans
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Matthew D Smyth
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Jennifer Strahle
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Jeffrey Leonard
- Department of Neurosurgery, Nationwide Children's Hospital, Columbus, OH, USA
| | - Samuel Cheshier
- Department of Neurosurgery, University of Utah, Salt Lake City, UT, USA
| | | | - Robert J Bollo
- Department of Neurosurgery, University of Utah, Salt Lake City, UT, USA
| | - John R Kestle
- Department of Neurosurgery, University of Utah, Salt Lake City, UT, USA
| | - John Honeycutt
- Department of Neurosurgery, Cook Children's Neurosciences, Forth Worth, TX, USA
| | - David J Donahue
- Department of Neurosurgery, Cook Children's Neurosciences, Forth Worth, TX, USA
| | - Richard A Roberts
- Department of Neurosurgery, Cook Children's Neurosciences, Forth Worth, TX, USA
| | - Daniel R Hansen
- Department of Neurosurgery, Cook Children's Neurosciences, Forth Worth, TX, USA
| | - Jay Riva-Cambrin
- Department of Neurosurgery, University of Calgary, Calgary, AB, Canada
| | | | - Clair Gallagher
- Department of Neurosurgery, University of Calgary, Calgary, AB, Canada
| | - Walter Hader
- Department of Neurosurgery, University of Calgary, Calgary, AB, Canada
| | - Yves Starreveld
- Department of Neurosurgery, University of Calgary, Calgary, AB, Canada
| | - Mark Hamilton
- Department of Neurosurgery, University of Calgary, Calgary, AB, Canada
| | - Ann-Christine Duhaime
- Department of Neurosurgery, Massachusetts General Hospital for Children, Boston, MA, USA
| | - Randy L Jensen
- Department of Neurosurgery, University of Utah, Salt Lake City, UT, USA. .,Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA.
| | - Michael R Chicoine
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, MO, USA
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Roder C, Breitkopf M, Ms, Bisdas S, Freitas RDS, Dimostheni A, Ebinger M, Wolff M, Tatagiba M, Schuhmann MU. Beneficial impact of high-field intraoperative magnetic resonance imaging on the efficacy of pediatric low-grade glioma surgery. Neurosurg Focus 2016; 40:E13. [PMID: 26926053 DOI: 10.3171/2015.11.focus15530] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Intraoperative MRI (iMRI) is assumed to safely improve the extent of resection (EOR) in patients with gliomas. This study focuses on advantages of this imaging technology in elective low-grade glioma (LGG) surgery in pediatric patients. METHODS The surgical results of conventional and 1.5-T iMRI-guided elective LGG surgery in pediatric patients were retrospectively compared. Tumor volumes, general clinical data, EOR according to reference radiology assessment, and progression-free survival (PFS) were analyzed. RESULTS Sixty-five patients were included in the study, of whom 34 had undergone conventional surgery before the iMRI unit opened (pre-iMRI period) and 31 had undergone surgery with iMRI guidance (iMRI period). Perioperative data were comparable between the 2 cohorts, apart from larger preoperative tumor volumes in the pre-iMRI period, a difference without statistical significance, and (as expected) significantly longer surgeries in the iMRI group. According to 3-month postoperative MRI studies, an intended complete resection (CR) was achieved in 41% (12 of 29) of the patients in the pre-iMRI period and in 71% (17 of 24) of those in the iMRI period (p = 0.05). Of those cases in which the surgeon was postoperatively convinced that he had successfully achieved CR, this proved to be true in only 50% of cases in the pre-iMRI period but in 81% of cases in the iMRI period (p = 0.055). Residual tumor volumes on 3-month postoperative MRI were significantly smaller in the iMRI cohort (p < 0.03). By continuing the resection of residual tumor after the intraoperative scan (when the surgeon assumed that he had achieved CR), the rate of CR was increased from 30% at the time of the scan to 85% at the 3-month postoperative MRI. The mean follow-up for the entire study cohort was 36.9 months (3-79 months). Progression-free survival after surgery was noticeably better for the entire iMRI cohort and in iMRI patients with postoperatively assumed CR, but did not quite reach statistical significance. Moreover, PFS was highly significantly better in patients with CRs than in those with incomplete resections (p < 0.001). CONCLUSIONS Significantly better surgical results (CR) and PFS were achieved after using iMRI in patients in whom total resections were intended. Therefore, the use of high-field iMRI is strongly recommended for electively planned LGG resections in pediatric patients.
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Affiliation(s)
| | | | - Ms
- Departments of 1 Neurosurgery and
| | | | | | | | - Martin Ebinger
- University Children's Hospital Tübingen, Eberhard Karls University, Tübingen, Germany
| | - Markus Wolff
- University Children's Hospital Tübingen, Eberhard Karls University, Tübingen, Germany
| | | | - Martin U Schuhmann
- Departments of 1 Neurosurgery and.,Section of Pediatric Neurosurgery; and
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Giordano M, Arraez C, Samii A, Samii M, Di Rocco C. Neurosurgical tools to extend tumor resection in pediatric hemispheric low-grade gliomas: iMRI. Childs Nerv Syst 2016; 32:1915-22. [PMID: 27659833 DOI: 10.1007/s00381-016-3177-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2016] [Accepted: 07/05/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION The treatment of low-grade gliomas (LGGs) in pediatric age is still controversial. However, most authors report longer life expectancy in case of completely removed cerebral gliomas. Intraoperative magnetic resonance imaging (iMRI) is increasingly utilized in the surgical management of intra-axial tumor in adults following the demonstration of its effectiveness. In this article, we analyze the management of LGG using iMRI focusing on its impact on resection rate and its limits in the pediatric population. METHODS We performed review of the literature regarding the treatment of LGG using iMRI focusing on its impact on resection rate and its limits in the pediatric population. Some exemplary cases are also described. RESULTS Intraoperative MRI allowed extension of tumor resection after the depiction of residual tumor at the intraoperative imaging control from 21 to 52 % of the cases in the published series. Moreover, the early reoperation rate was significantly lower when compared with the population treated without this tool (0 % vs 7-14 %). Some technical difficulties have been described in literature regarding the use of iMRI in the pediatric population especially for positioning due to the structure of the headrest coil designed for adult patients. CONCLUSION The analysis of the literature and our own experience with iMRI in children indicates significant advantages in the resection of LGG offered by the technique. All these advantages are obtained without elongation of the surgical times or increased risk for complications, namely infection. The main limit for a wider diffusion of iMRI for the pediatric neurosurgical center is the cost required, for acquisition of the system, especially for high-field magnet, and the environmental and organizational changes necessary for its use.
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Affiliation(s)
- Mario Giordano
- Department of Neurosurgery, International Neuroscience Institute, Rudolf Pichlmayr Str. 4, 30625, Hannover, Germany.
| | - Cinta Arraez
- Department of Neurosurgery, International Neuroscience Institute, Rudolf Pichlmayr Str. 4, 30625, Hannover, Germany
| | - Amir Samii
- Department of Neurosurgery, International Neuroscience Institute, Rudolf Pichlmayr Str. 4, 30625, Hannover, Germany
| | - Madjid Samii
- Department of Neurosurgery, International Neuroscience Institute, Rudolf Pichlmayr Str. 4, 30625, Hannover, Germany
| | - Concezio Di Rocco
- Department of Neurosurgery, International Neuroscience Institute, Rudolf Pichlmayr Str. 4, 30625, Hannover, Germany
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Abstract
Intraoperative magnetic resonance imaging (iMRI) has emerged as an important tool in guiding the surgical management of children with brain tumors. Recent advances have allowed utilization of high field strength systems, including 3-tesla MRI, resulting in diagnostic-quality scans that can be performed while the child is on the operating table. By providing information about the possible presence of residual tumor, it allows the neurosurgeon to both identify and resect any remaining tumor that is thought to be safely accessible. By fusing the newly obtained images with the surgical guidance software, the images have the added value of aiding in navigation to any residual tumor. This is important because parenchyma often shifts during surgery. It also gives the neurosurgeon insight into whether any immediate postoperative complications have occurred. If any complications have occurred, the child is already in the operating room and precious minutes lost in transport and communications are saved. In this article we review the three main approaches to an iMRI system design. We discuss the possible roles for iMRI during intraoperative planning and provide guidance to help radiologists and neurosurgeons alike in the collaborative management of these children.
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Boop FA, Bate B, Choudhri AF, Burkholder B, Klimo P. Preliminary experience with an intraoperative MRI-compatible infant headholder: technical note. J Neurosurg Pediatr 2015; 15:539-43. [PMID: 25679382 DOI: 10.3171/2014.10.peds14447] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The development of high-quality intraoperative MRI (iMRI) capability has offered a major advance in the care of patients with complex intracranial disease. To date, this technology has been limited by the need for pin fixation of the calvaria. The authors report their preliminary experience with an MRI-compatible horseshoe headrest that allows for the following: 1) iMRI in patients too young for pin fixation; 2) iMRI in patients with large calvarial defects; 3) the ability to move the head during iMRI surgery; and 4) the use of neuronavigation in such cases. The authors report 2 cases of infants in whom the Visius Surgical Theatre horseshoe headrest (IMRIS Inc.) was used. Image quality was equivalent to that of pin fixation. The infants suffered no skin issues. The use of neuronavigation with the system remained accurate and could be updated with the new iMRI information. The Visius horseshoe headrest offers a technical advance in iMRI technology for infants, for patients with cranial defects or prior craniotomies in whom pin fixation may not be safe, or for patients in whom the need to move the head during surgery is required. The image quality of the system remains excellent, and the ability to merge new images to the neuronavigation system is helpful.
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Choudhri AF, Klimo P, Auschwitz TS, Whitehead MT, Boop FA. 3T intraoperative MRI for management of pediatric CNS neoplasms. AJNR Am J Neuroradiol 2014; 35:2382-7. [PMID: 25059696 DOI: 10.3174/ajnr.a4040] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
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.
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Affiliation(s)
- A F Choudhri
- From 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
| | - P Klimo
- Neurosurgery (A.F.C., P.K., T.S.A., F.A.B.) Le Bonheur Neuroscience Institute (A.F.C., P.K., M.T.W., F.A.B.), Le Bonheur Children's Hospital, Memphis, Tennessee Semmes-Murphey Neurologic and Spine Institute (P.K., F.A.B.), Memphis, Tennessee Division of Neurosurgery (P.K., F.A.B.), and Department of Surgery, St. Jude Children's Hospital, Memphis, Tennessee
| | | | - M T Whitehead
- From the Departments of Radiology (A.F.C., M.T.W.) Le Bonheur Neuroscience Institute (A.F.C., P.K., M.T.W., F.A.B.), Le Bonheur Children's Hospital, Memphis, Tennessee Department of Radiology (M.T.W.), Children's National Medical Center, Washington, DC
| | - F A Boop
- Neurosurgery (A.F.C., P.K., T.S.A., F.A.B.) Le Bonheur Neuroscience Institute (A.F.C., P.K., M.T.W., F.A.B.), Le Bonheur Children's Hospital, Memphis, Tennessee Semmes-Murphey Neurologic and Spine Institute (P.K., F.A.B.), Memphis, Tennessee Division of Neurosurgery (P.K., F.A.B.), and Department of Surgery, St. Jude Children's Hospital, Memphis, Tennessee
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Abstract
Since the advent of intraoperative magnetic resonance imaging (ioMRI) at the Brigham and Women's Hospital in 1994, ioMRI has spread widely and in many different forms. This article traces the developmental history of ioMRI and reviews the relevant literature regarding it's effectiveness in pediatric neurosurgery. While of considerable expense, current trends in healthcare essentially mandate the use of ioMRI in a growing number of cases.
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Affiliation(s)
- Ian Mutchnick
- Pediatric Neurosurgery, Kosair Children's Hospital, Norton Neuroscience Institute, Louisville, KY 40202, USA
| | - Thomas M Moriarty
- Pediatric Neurosurgery, Kosair Children's Hospital, Norton Neuroscience Institute, Louisville, KY 40202, USA
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Implementation of a mobile 0.15-T intraoperative MR system in pediatric neuro-oncological surgery: feasibility and correlation with early postoperative high-field strength MRI. Childs Nerv Syst 2012; 28:1171-80. [PMID: 22684477 PMCID: PMC3402673 DOI: 10.1007/s00381-012-1815-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2011] [Accepted: 05/18/2012] [Indexed: 11/02/2022]
Abstract
INTRODUCTION We analyze our preliminary experience using the PoleStar N20 mobile intraoperative MR (iMR) system as an adjunct for pediatric brain tumor resection. METHODS We analyzed 11 resections in nine children between 1 month and 17 years old. After resection, we acquired iMR scans to detect residual tumor and update neuronavigation. We compared final iMR interpretation by the neurosurgeon with early postoperative MR interpretation by a neuroradiologist. RESULTS Patient positioning was straightforward, and image quality (T1 7-min 4-mm sequences) sufficient in all cases. In five cases, contrast enhancement suspect for residual tumor was noted on initial postresection iMR images. In one case, a slight discrepancy with postoperative imaging after 3 months was no longer visible after 1 year. No serious perioperative adverse events related to the PoleStar N20 were encountered, except for transient shoulder pain in two. CONCLUSIONS Using the PoleStar N20 iMR system is technically feasible and safe for both supra- and infratentorial tumor resections in children of all ages. Their small head and shoulders favor positioning in the magnet bore and allow the field of view to cover more than the area of primary interest, e.g., the ventricles in an infratentorial case. Standard surgical equipment may be used without significant limitations. In this series, the use of iMR leads to an increased extent of tumor resection in 45 % of cases. Correlation between iMR and early postoperative MR is excellent, provided image quality is optimal and interpretation is carefully done by someone sufficiently familiar with the system.
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Ulrich NH, Burkhardt JK, Serra C, Bernays RL, Bozinov O. Resection of pediatric intracerebral tumors with the aid of intraoperative real-time 3-D ultrasound. Childs Nerv Syst 2012; 28:101-9. [PMID: 21927834 DOI: 10.1007/s00381-011-1571-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2011] [Accepted: 08/30/2011] [Indexed: 11/28/2022]
Abstract
PURPOSE Intraoperative ultrasound (IOUS) has become a useful tool employed daily in neurosurgical procedures. In pediatric patients, IOUS offers a radiation-free and safe imaging method. This study aimed to evaluate the use of a new real-time 3-D IOUS technique (RT-3-D IOUS) in our pediatric patient cohort. MATERIAL AND METHODS Over 24 months, RT-3-D IOUS was performed in 22 pediatric patients (8 girls and 14 boys) with various brain tumors. These lesions were localized by a standard navigation system followed by analyses before, intermittently during, and after neurosurgical resection using the iU22 ultrasound system (Philips, Bothell, USA) connected to the RT-3-D probe (X7-2). RESULTS In all 22 patients, real-time 3-D ultrasound images of the lesions could be obtained during neurosurgical resection. Based on this imaging method, rapid orientation in the surgical field and the approach for the resection could be planned for all patients. In 18 patients (82%), RT-3-D IOUS revealed a gross total resection with a favorable neurological outcome. CONCLUSION RT-3-D IOUS provides the surgeon with advanced orientation at the tumor site via immediate live two-plane imaging. However, navigation systems have yet to be combined with RT-3-D IOUS. This combination would further improve intraoperative localization.
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Affiliation(s)
- Nils H Ulrich
- Department of Neurosurgery, University Hospital Zurich, Frauenklinikstr.10, 8091 Zurich, Switzerland.
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Gasser T, Senft C, Rathert J, Friedrich K, Hattingen E, Gerlach R, Seifert V. The combination of semi-sitting position and intraoperative MRI--first report on feasibility. Acta Neurochir (Wien) 2010; 152:947-51. [PMID: 20169370 DOI: 10.1007/s00701-010-0607-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2009] [Accepted: 01/21/2010] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Intraoperative MRI (iMRI) has been established as a routine imaging modality with a remarkable impact on specific neurosurgical procedures. The technological advancement continuously extends the spectrum of iMRI, leading to an increasing number of installations. Yet, procedures in which a semi-sitting position would be advantageous were beyond the reach of iMRI. MATERIALS AND METHODS We performed an iMRI-guided surgical procedure in a patient with a cystic lesion of the inferior parieto-occipital lobe while the patient was placed in a semi-sitting position, employing a mobile 0.15-T intraoperative MRI system. For that purpose, we adapted a standard OR table according to the needs of iMRI. FINDINGS Patient positioning could be accomplished easily. For intraoperative scanning, the OR table was tilted backwards so as to position the patient's head in the magnet's aperture. Obtained images were used for neuronavigated cyst evacuation via burr hole trephination after repositioning the OR table. Subsequent intraoperative imaging documented collapse of the cyst at the end of the procedure. There were no adverse effects resulting from the combination of semi-sitting position and iMRI guidance. CONCLUSION This report demonstrates for the first time that the combination of iMRI and the semi-sitting position is feasible and that this procedure bears specific benefits. Issues such as brain shift due to table tilting warrant further investigations in order to expand this technique to posterior fossa craniotomies.
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Affiliation(s)
- Thomas Gasser
- Department of Neurosurgery, University of Duisburg-Essen, Hufelandstr. 55, 45122 Essen, Germany.
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Abstract
Neurosurgical diagnosis and intervention has evolved through improved neuroimaging, allowing better visualization of anatomy and pathology. This article discusses the various systems that have been designed over the last decade to meet the requirements of neurosurgical patients and opines on the potential future developments in the technology and application of intraoperative MRI. Because the greatest amount of experience with intraoperative MRI comes from its use in brain tumor resection, this article focuses on the origins of intraoperative MRI in relation to this field.
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Levy R, Cox RG, Hader WJ, Myles T, Sutherland GR, Hamilton MG. Application of intraoperative high-field magnetic resonance imaging in pediatric neurosurgery. J Neurosurg Pediatr 2009; 4:467-74. [PMID: 19877782 DOI: 10.3171/2009.4.peds08464] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Over the past decade, the use of intraoperative MR (iMR) imaging in the pediatric neurosurgical population has become increasingly accepted as an innovative and important neurosurgical tool. The authors summarize their experience using a mobile 1.5-T iMR imaging unit with integrated neuronavigation with the goal of identifying procedures and/or pathologies in which the application of this technology changed the course of surgery or modified the operative strategy. METHODS A database has been prospectively maintained for this patient population. The authors reviewed the hospital charts and imaging results for all patients in the database. This review revealed 105 neurosurgical procedures performed in 98 children (49 male and 49 female) between March 1998 and April 2008. Intradissection (ID) and/or quality assurance images were obtained at the discretion of the surgeon. RESULTS The median age at surgery was 12 years (4 months-18 years). One hundred intracranial and 5 spinal procedures were performed; 22 of these procedures were performed for recurrent pathology. Surgical planning scans were obtained for 102 procedures, and neuronavigation was used in 93 patients. The greatest impact of iMR imaging was apparent in the 55 procedures to resect neoplastic lesions; ID scans were obtained in 49 of these procedures. Further surgery was performed in 49% of the procedures during which ID scans had been obtained. A smaller proportion of ID scans in the different cranial pathology groups (5 of 21 epilepsy cases, 4 of 9 vascular cases) resulted in further resections to meet the surgical goal of the surgeon. Two ID scans obtained during 5 procedures for the treatment of spinal disease did not lead to any change in surgery. Postoperative scans did not reveal any acute adverse events. There was 1 intraoperative adverse event in which a Greenberg retractor was inadvertently left on during ID scanning but was removed after the scout scans. CONCLUSIONS The application of iMR imaging in the pediatric neurosurgical population allows, at minimum, the opportunity to perform less invasive surgical exposures. Its potential is greatest when its high-quality imaging ability is coupled with its superior neuronavigation capabilities, which permits tracking of the extent of resection of intracranial tumors and, to a lesser extent, other lesions during the surgical procedure.
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Affiliation(s)
- Ron Levy
- Division of Neurosurgery, Department of Clinical Neuroscience, Faculty of Medicine, University of Calgary, Foothills Medical Centre, Calgary, Alberta, Canada
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16
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Abstract
Neurosurgical diagnosis and intervention has evolved through improved neuroimaging, allowing better visualization of anatomy and pathology. This article discusses the various systems that have been designed over the last decade to meet the requirements of neurosurgical patients and opines on the potential future developments in the technology and application of intraoperative MRI. Because the greatest amount of experience with intraoperative MRI comes from its use in brain tumor resection, this article focuses on the origins of intraoperative MRI in relation to this field.
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Affiliation(s)
- John M K Mislow
- Department of Neurosurgery, Harvard Medical School, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA
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17
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Roth J, Biyani N, Beni-Adani L, Constantini S. Real-time neuronavigation with high-quality 3D ultrasound SonoWand in pediatric neurosurgery. Pediatr Neurosurg 2007; 43:185-91. [PMID: 17409787 DOI: 10.1159/000098830] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Intraoperative ultrasound (IOUS) serves as a basic imaging tool in neurosurgery. However, its low quality and difficulty in interpreting the images make its use as a resection control tool and navigation system cumbersome. We present our experience using a high-resolution 3D IOUS system combined with a navigation system in pediatric cranial surgery. We retrospectively reviewed 16 pediatric neurosurgical procedures in which a high-resolution 3D IOUS combined with a navigation system was used. The system enables basic navigation based on preoperative computed tomography or magnetic resonance imaging scans. In addition, IOUS images serve as a data set for updated intraoperative navigation. The indications for IOUS were preoperative navigation to define the skin incision and exact craniotomy site, and for real-time neuronavigation and resection control during tumor removal. The added time per case was short and no technical difficulties were encountered. High-resolution 3D IOUS combined with navigation systems has advantages for the pediatric neurosurgical population, including both real-time basic navigation and improved resection control.
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Affiliation(s)
- Jonathan Roth
- Department of Pediatric Neurosurgery, Dana Children's Hospital, Tel-Aviv Medical Center, Tel Aviv, Israel
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Roth J, Beni-Adani L, Biyani N, Constantini S. Classical and real-time neuronavigation in pediatric neurosurgery. Childs Nerv Syst 2006; 22:1065-71. [PMID: 16761161 DOI: 10.1007/s00381-006-0103-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2005] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Neuronavigation has become a cornerstone of neurosurgery. Navigation systems are categorized into two main groups: those based on preoperative imaging and those based on real-time intraoperative acquired images. OBJECTIVES The preoperative imaging systems, either computed tomography (CT)- or magnetic resonance imaging (MRI)-based, are straight-forward systems that are routinely used in most institutions. Image accuracy, however, decreases secondary to brain and lesion shifts that occur during surgery. Intraoperative, real-time navigation systems overcome anatomical shifts by updating the image base of the navigation during surgery, thus, maintaining precise navigation capabilities throughout the surgical procedure. CONCLUSIONS In this article, we review the main neuronavigation systems and their applications, emphasizing their unique advantages and usage within the pediatric population.
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Affiliation(s)
- Jonathan Roth
- Department of Pediatric Neurosurgery, Dana Children's Hospital, Tel-Aviv Sourasky Medical Center, 64239 Tel Aviv, Israel
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Abstract
Craniopharyngiomas are rare, mainly sellar/parasellar, epithelial tumors diagnosed during childhood or adult life. Histologically, two primary subtypes have been recognized (adamantinomatous and papillary) with an as yet, unclarified pathogenesis. They may present with a variety of manifestations (neurological, visual, and hypothalamo-pituitary). Despite their benign histological appearance, they often show an unpredictable growth pattern, which, combined with the lack of randomized studies, poses significant difficulties in the establishment of an optimal therapeutic protocol. This should focus on the prevention of recurrence(s), improvement of survival, reduction of the significant disease and treatment-related morbidity (endocrine, visual, hypothalamic, neurobehavioral, and cognitive), and preservation of the quality of life. Currently, surgical excision followed by external beam irradiation, in cases of residual tumor, is the main treatment option. Intracystic irradiation or bleomycin, stereotactic radiosurgery, or radiotherapy and systemic chemotherapy are alternative approaches; their place in the management plan remains to be assessed in adequately powered long-term trials. Apart from the type of treatment, the identification of clinical and imaging parameters that will predict patients with a better prognosis is difficult. The central registration of patients with these challenging tumors may provide correlates between treatments and outcomes and establish prognostic factors at the pathological or molecular level that may further guide us in the future.
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Affiliation(s)
- Niki Karavitaki
- Department of Endocrinology, Oxford Centre for Diabetes, Endocrinology and Metabolism, Churchill Hospital, Old Road, Headington, Oxford OX3 7LJ, United Kingdom
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Roth J, Beni Adani L, Biyani N, Constantini S. Intraoperative portable 0.12-tesla MRI in pediatric neurosurgery. Pediatr Neurosurg 2006; 42:74-80. [PMID: 16465075 DOI: 10.1159/000090459] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2005] [Accepted: 07/13/2005] [Indexed: 01/23/2023]
Abstract
OBJECTIVES Intraoperative MRI (iMRI) is used mainly in the adult neurosurgical population. The main indications for iMRI usage are resection control and updated intraoperative navigation capabilities. In this paper we present our experience using this technique in children. Specific advantages of iMRI for this age group are discussed. METHODS AND RESULTS We retrospectively reviewed 31 pediatric neurosurgical procedures in which a portable iMRI system was used. The indications for iMRI usage were preoperative navigation, resection control during tumor removal, shunt placements, and needle biopsy. In 7 children the use of the iMRI changed the course of the surgical procedure. Operative morbidity and mortality were not increased with use of the iMRI. CONCLUSIONS iMRI systems have advantages for the pediatric neurosurgical population, including both real-time basic navigation and improved resection control.
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Affiliation(s)
- Jonathan Roth
- Department of Pediatric Neurosurgery, Dana Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
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