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Yan Y, Kaderali Z, Chowdhury T, Shankar J. Feasibility of intraoperative MRI for endovascular coiling of intracranial aneurysms: A single centre experience. Interv Neuroradiol 2023; 29:520-524. [PMID: 35538892 PMCID: PMC10549709 DOI: 10.1177/15910199221100962] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 03/24/2022] [Accepted: 04/27/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Intraoperative magnetic resonance imaging system (iMRIS) surgical theatre is a highly integrated operating room with an intraoperative magnetic resonance imaging (iMRI) designed originally for brain tumour surgery. Its use in neurointerventional procedures, particularly in the setting of endovascular coiling of intracranial aneurysms, has not been discussed in the literature to date. We present our initial experience about the safety and feasibility of iMRI to assess post operative complications and provide baseline imaging post coiling of intracranial aneurysms. METHODS Consecutive patients who underwent iMRI between 2015 and 2018 were included in the study. Demographic, clinical details, endovascular technique and surgical outcomes were collected. Details of anesthesia during the procedure were also collected. RESULTS Fifteen patients underwent iMRI with MRA to assess post coiling status of their elective endovascular coiling of intracranial aneurysms. The mean age in this cohort was 61 years and 46.7% were male. No immediate complications were seen either from the endovascular procedures or from the iMRI. All iMRI scans were performed as planned with no aborted or truncated scans. The image quality of the iMRI/MRA was adequate to detect the residual aneurysm, if present. There was no residual aneurysm on the angiogram that were not detected on the iMRIs. Of the 15 patients, 10 were safely discharged the following day and other 5 were discharged 2 days after their surgery. CONCLUSIONS The iMRI is an advantageous tool which can be integrated into neurointerventional workflow resulting in early post peri-procedural feedback and potentially reduced post-operative hospital stay.
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Affiliation(s)
- Yi Yan
- Rady Faculty of Health Sciences, Radiology Department, University of Manitoba, Winnipeg, MB, Canada
| | - Zul Kaderali
- Section of Neurosurgery, Health Sciences Centre, University of Manitoba, Winnipeg, MB, Canada
| | - Tumul Chowdhury
- Rady Faculty of Health Sciences, Department of Anesthesiology, Perioperative and Pain Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Jai Shankar
- Rady Faculty of Health Sciences, Radiology Department, University of Manitoba, Winnipeg, MB, Canada
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2
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Bsat S, Alshareef M, Pazniokas J, Handler MH. Technical evolution of pediatric neurosurgery: the evolution of intraoperative imaging. Childs Nerv Syst 2023; 39:2605-2611. [PMID: 37518061 DOI: 10.1007/s00381-023-06040-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 06/17/2023] [Indexed: 08/01/2023]
Abstract
Imaging has always been fundamental to neurosurgery, and its evolution over the last century has made a dramatic transformation in the ability of neurosurgeons to define pathology and preserve normal tissue during their operations. In the mid-70 s, the development of computerized cross-sectional imaging with CT scan and subsequently MRI have revolutionized the practice of neurosurgery. Later, further advances in computer technology and medical engineering have allowed the combination of many modalities to bring them into the operating theater. This evolution has allowed real-time intraoperative imaging, in the hope of helping neurosurgeons achieve accuracy, maximal safe resection, and the implementation of minimally invasive techniques in brain and spine pathologies. Augmented reality and robotic technologies are also being applied as useful intra-operative techniques that will improve surgical planning and outcomes in the future. In this article, we will review imaging modalities and provide our institutional perspective on how we have integrated them into our practice.
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Affiliation(s)
- Shadi Bsat
- Department of Neurological Surgery, University of Colorado School of Medicine, Aurora, CO, USA
- Children's Hospital Colorado, Aurora, CO, USA
| | - Mohammed Alshareef
- Department of Neurological Surgery, University of Colorado School of Medicine, Aurora, CO, USA
- Children's Hospital Colorado, Aurora, CO, USA
| | - Julia Pazniokas
- Department of Neurological Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Michael H Handler
- Department of Neurological Surgery, University of Colorado School of Medicine, Aurora, CO, USA.
- Children's Hospital Colorado, Aurora, CO, USA.
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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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Burke JF, Tanzillo D, Starr PA, Lim DA, Larson PS. CT and MRI Image Fusion Error: An Analysis of Co-Registration Error Using Commercially Available Deep Brain Stimulation Surgical Planning Software. Stereotact Funct Neurosurg 2021; 99:196-202. [PMID: 33535219 DOI: 10.1159/000511114] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 08/24/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION During deep brain stimulation (DBS) surgery, computed tomography (CT) and magnetic resonance imaging (MRI) scans need to be co-registered or fused. Image fusion is associated with the error that can distort the location of anatomical structures. Co-registration in DBS surgery is usually performed automatically by proprietary software; the amount of error during this process is not well understood. Here, our goal is to quantify the error during automated image co-registration with FrameLink™, a commonly used software for DBS planning and clinical research. METHODS This is a single-center retrospective study at a quaternary care referral center, comparing CT and MR imaging co-registration for a consecutive series of patients over a 12-month period. We collected CT images and MRI scans for 22 patients with Parkinson's disease requiring placement of DBS. Anatomical landmarks were located on CT images and MRI scans using a novel image analysis algorithm that included a method for capturing the potential error inherent in the image standardization step of the analysis. The distance between the anatomical landmarks was measured, and the error was found by averaging the distances across all patients. RESULTS The average error during co-registration was 1.25 mm. This error was significantly larger than the error resulting from image standardization (0.19 mm) and was worse in the anterior-posterior direction. CONCLUSIONS The image fusion errors found in this analysis were nontrivial. Although the estimated error may be inflated, it is sig-nificant enough that users must be aware of this potential inaccuracy, and developers of proprietary software should provide details about the magnitude and direction of co-registration errors.
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Affiliation(s)
- John F Burke
- Department of Neurological Surgery, University of California, San Francisco, California, USA,
| | | | - Philip A Starr
- Department of Neurological Surgery, University of California, San Francisco, California, USA.,Surgical Service, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
| | - Daniel A Lim
- Department of Neurological Surgery, University of California, San Francisco, California, USA.,Surgical Service, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
| | - Paul S Larson
- Department of Neurological Surgery, University of California, San Francisco, California, USA.,Surgical Service, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
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Parikh KA, Venable GT, Orr BA, Choudhri AF, Boop FA, Gajjar AJ, Klimo P. Pineoblastoma-The Experience at St. Jude Children's Research Hospital. Neurosurgery 2018; 81:120-128. [PMID: 28327927 DOI: 10.1093/neuros/nyx005] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 01/20/2017] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Pineoblastomas are rare, supratentorial, primitive neuroectodermal tumors. OBJECTIVE To document outcomes with multimodal therapy and evaluate the impact that the degree of surgical resection has on outcome. METHODS A departmental brain tumor database was queried to identify all patients with pathologically proven pineoblastoma who were treated from January 1997 to June 2015 at St. Jude Children's Research Hospital. For each patient, we recorded demographic, pathological, radiological, surgical, and clinical follow-up data. The effect of degree of surgical resection on survival outcomes was analyzed. RESULTS Forty-one patients (21 male, 20 female) treated for pineoblastoma were identified. The median age at diagnosis was 5.5 years (range 0.4-28.1) and the median follow-up was 34.5 months. Nineteen patients experienced tumor relapse with a median progression-free survival of 11.3 months, and 18 ultimately succumbed to their disease. Patients who died or experienced treatment failure were younger (median, 2.69 vs 6.5 years, P = .026) and more likely to have metastatic disease at diagnosis (12 [63.2%] vs 5 [22.7%], P = .012). When analyzing only patients 5 years of age or older with focal disease at presentation, those who had a gross total resection or near-total resection-compared with subtotal resection or biopsy-had greater overall survival (75.18 vs 48.57 months), with no patients dying as a result of their cancer. CONCLUSION Poor prognostic variables for children with pineoblastoma include young age, metastatic disease at presentation, and tumor relapse. For patients older than 5 years with focal disease, maximal tumor resection should be the goal.
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Affiliation(s)
- Kara A Parikh
- School of Medicine, Louisiana State University Health Science Center, New Orleans, Louisiana.,Department of Surgery, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Garrett T Venable
- Department of Surgery, St. Jude Children's Research Hospital, Memphis, Tennessee.,Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Brent A Orr
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Asim F Choudhri
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee.,Le Bonheur Neuroscience Institute, Le Bonheur Children's Hospital, Memphis, Tennessee.,Department of Radiology, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Frederick A Boop
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee.,Le Bonheur Neuroscience Institute, Le Bonheur Children's Hospital, Memphis, Tennessee.,Semmes Murphey Clinic, Memphis, Tennessee
| | - Amar J Gajjar
- Department of Oncology, Division of NeuroOncology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Paul Klimo
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee.,Department of Pathology, St. Jude Children's Research Hospital, Memphis, Tennessee.,Le Bonheur Neuroscience Institute, Le Bonheur Children's Hospital, Memphis, Tennessee.,Semmes Murphey Clinic, Memphis, Tennessee
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Choudhri AF, Siddiqui A, Klimo P. Pediatric Cerebellar Tumors: Emerging Imaging Techniques and Advances in Understanding of Genetic Features. Magn Reson Imaging Clin N Am 2017; 24:811-821. [PMID: 27742118 DOI: 10.1016/j.mric.2016.07.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Cerebellar tumors are the most common group of solid tumors in children. MR imaging provides an important role in characterization of these lesions, surgical planning, and postsurgical surveillance. Preoperative imaging can help predict the histologic subtype of tumors, which can provide guidance for surgical planning. Beyond histology, pediatric brain tumors are undergoing new classification schemes based on genetic features. Intraoperative MR imaging has emerged as an important tool in the surgical management of pediatric brain tumors. Effective understanding of the imaging features of pediatric cerebellar tumors can benefit communication with neurosurgeons and neuro-oncologists and can improve patient management.
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Affiliation(s)
- Asim F Choudhri
- Department of Radiology, University of Tennessee Health Science Center, 848 Adams Ave, Memphis, TN 38103, USA; Department of Neurosurgery, University of Tennessee Health Science Center, 847 Monroe Avenue, Memphis, TN 38163, USA; Department of Ophthalmology, University of Tennessee Health Science Center, 930 Madison Avenue, Memphis, TN 38163, USA; Le Bonheur Neuroscience Institute, Le Bonheur Children's Hospital, 848 Adams Avenue, Memphis, TN 38103, USA.
| | - Adeel Siddiqui
- Department of Radiology, University of Tennessee Health Science Center, 848 Adams Ave, Memphis, TN 38103, USA; Le Bonheur Neuroscience Institute, Le Bonheur Children's Hospital, 848 Adams Avenue, Memphis, TN 38103, USA
| | - Paul Klimo
- Department of Neurosurgery, University of Tennessee Health Science Center, 847 Monroe Avenue, Memphis, TN 38163, USA; Le Bonheur Neuroscience Institute, Le Bonheur Children's Hospital, 848 Adams Avenue, Memphis, TN 38103, USA; Division of Neurosurgery, St. Jude's Children's Hospital, 262 Danny Thomas Place, Memphis, TN 38105, USA; Semmes Murphey Neurologic & Spine Institute, 6325 Humphreys Boulevard, Memphis, TN 38120, USA
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7
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Giordano M, Samii A, Lawson McLean AC, Bertalanffy H, Fahlbusch R, Samii M, Di Rocco C. Intraoperative magnetic resonance imaging in pediatric neurosurgery: safety and utility. J Neurosurg Pediatr 2017; 19:77-84. [PMID: 27791707 DOI: 10.3171/2016.8.peds15708] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The use of high-field intraoperative MRI has been largely studied for the treatment of intracranial tumors in adult patients. In this study, the authors investigated the safety, advantages, and limitations of high-field iMRI for cranial neurosurgical procedures in pediatric patients, with particular attention to craniopharyngiomas and gliomas. METHODS The authors performed 82 surgical procedures in patients under 16 years of age (range 0.8-15 years) over an 8-year period (2007-2014) using iMRI. The population was divided into 3 groups based on the condition treated: sellar region tumors (Group 1), gliomas (Group 2), and other pathological entities (Group 3). The patients' pre- and postoperative neurological status, the presence of residual tumor, the number of intraoperative scans, and complications were evaluated. RESULTS In Group 1, gross-total resection (GTR) was performed in 22 (88%) of the procedures and subtotal resection (STR) in 3 (12%). In Group 2, GTR, STR, and partial resection (PR) were performed, respectively, in 15 (56%), 7 (26%), and 5 (18%) of the procedures. In Group 3, GTR was performed in 28 (93%) and STR in 2 (7%) of the procedures. In cases of craniopharyngioma (Group 1) and glioma (Group 2) in which a complete removal was planned, iMRI allowed localization of residual lesions and attainment of the surgical goal through further resection, respectively, in 18% and 27% of the procedures. Moreover, in gliomas the resection could be extended from partial to subtotal in 50% of the cases. In 17% of the patients in Group 3, iMRI enabled the identification and further removal of tumor remnants. There was no intra- or postoperative complication related to the use of iMRI despite special technical difficulties in smaller children. CONCLUSIONS In this study, the use of iMRI in children proved to be safe. It was most effective in increasing the extent of tumor resection, especially in patients with low-grade gliomas and craniopharyngiomas. The most prominent disadvantage of high-field iMRI was the limitation with respect to operative positioning due to the configuration of the surgical table.
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Affiliation(s)
- Mario Giordano
- Department of Neurosurgery, International Neuroscience Institute, Hannover; and
| | - Amir Samii
- Department of Neurosurgery, International Neuroscience Institute, Hannover; and.,Leibniz Institute for Neurobiology, Magdeburg, Germany
| | | | - Helmut Bertalanffy
- Department of Neurosurgery, International Neuroscience Institute, Hannover; and
| | - Rudolf Fahlbusch
- Department of Neurosurgery, International Neuroscience Institute, Hannover; and
| | - Madjid Samii
- Department of Neurosurgery, International Neuroscience Institute, Hannover; and
| | - Concezio Di Rocco
- Department of Neurosurgery, International Neuroscience Institute, Hannover; and
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Patel PG, Cohen-Gadol AA, Mercier P, Boop FA, Klimo P. The Posterior Transcallosal Approach to the Pineal Region and Posterior Third Ventricle: Intervenous and Paravenous Variants. Oper Neurosurg (Hagerstown) 2016; 13:77-88. [DOI: 10.1227/neu.0000000000001268] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Accepted: 03/01/2016] [Indexed: 11/19/2022] Open
Abstract
Abstract
BACKGROUND: There are a number of surgical approaches to the posterior third ventricle and pineal region, each with its associated advantages and disadvantages.
OBJECTIVE: To present our experience with the posterior interhemispheric transcallosal approach and to analyze the indications, technique, and outcomes.
METHODS: A retrospective study was conducted to identify and analyze all children and young adults who underwent the posterior transcallosal approach from July 2010 to March 2015. Perioperative data included patient demographics, signs and symptoms on presentation, tumor characteristics (type, origin, and size), complications, and clinical and radiographic outcome at final follow-up.
RESULTS: Twenty-two patients (9 female, 13 male) were identified in 24 cases with a mean age of 10.5 years (range, 3-32 years). The most common tumor type was pineoblastoma (n = 6). Eleven patients underwent gross total resections; 11 underwent subtotal resections; and 2 tumors were biopsied. The intervenous operative corridor was used in 15 cases; the paravenous was used in 9. Of the 22 patients, 19 experienced 31 total postoperative events. There were 12 instances of contralateral weakness. Retraction-related hemiparesis was usually temporary; resection-related hemiparesis lasted longer. There were no complications related to occlusion of one or more bridging cortical veins or from thrombosis of 1 internal cerebral vein. Eight patients have died of tumor progression, and of the remaining 14 patients, only 1 patient to date has developed local progression.
CONCLUSION: The posterior interhemispheric transcallosal approach allows resection of tumors located within the pineal region, posterior third ventricle, and thalamus. New postoperative neurological deficits can occur; however, many will improve significantly or resolve completely over time.
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Affiliation(s)
- Prayash G. Patel
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Aaron A. Cohen-Gadol
- Goodman Camp-bell Brain and Spine and Indiana University Department of Neurosurgery, Indianapolis, Indiana
| | - Philippe Mercier
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Frederick A. Boop
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee
- Semmes-Murphey Neurologic and Spine Institute, Memphis, Tennessee
- St. Jude Children's Research Hospital, Memphis, Tennessee
- Le Bonheur Neuroscience Institute, Le Bonheur Children's Hospital, Memphis, Tennessee
| | - Paul Klimo
- Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee
- Semmes-Murphey Neurologic and Spine Institute, Memphis, Tennessee
- St. Jude Children's Research Hospital, Memphis, Tennessee
- Le Bonheur Neuroscience Institute, Le Bonheur Children's Hospital, Memphis, Tennessee
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Choudhri AF, Siddiqui A, Klimo P. Pediatric Cerebellar Tumors: Emerging Imaging Techniques and Advances in Understanding of Genetic Features. Neuroimaging Clin N Am 2016; 26:459-69. [PMID: 27423803 DOI: 10.1016/j.nic.2016.03.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Cerebellar tumors are the most common group of solid tumors in children. MR imaging provides an important role in characterization of these lesions, surgical planning, and postsurgical surveillance. Preoperative imaging can help predict the histologic subtype of tumors, which can provide guidance for surgical planning. Beyond histology, pediatric brain tumors are undergoing new classification schemes based on genetic features. Intraoperative MR imaging has emerged as an important tool in the surgical management of pediatric brain tumors. Effective understanding of the imaging features of pediatric cerebellar tumors can benefit communication with neurosurgeons and neuro-oncologists and can improve patient management.
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Affiliation(s)
- Asim F Choudhri
- Department of Radiology, University of Tennessee Health Science Center, 848 Adams Ave, Memphis, TN 38103, USA; Department of Neurosurgery, University of Tennessee Health Science Center, 847 Monroe Avenue, Memphis, TN 38163, USA; Department of Ophthalmology, University of Tennessee Health Science Center, 930 Madison Avenue, Memphis, TN 38163, USA; Le Bonheur Neuroscience Institute, Le Bonheur Children's Hospital, 848 Adams Avenue, Memphis, TN 38103, USA.
| | - Adeel Siddiqui
- Department of Radiology, University of Tennessee Health Science Center, 848 Adams Ave, Memphis, TN 38103, USA; Le Bonheur Neuroscience Institute, Le Bonheur Children's Hospital, 848 Adams Avenue, Memphis, TN 38103, USA
| | - Paul Klimo
- Department of Neurosurgery, University of Tennessee Health Science Center, 847 Monroe Avenue, Memphis, TN 38163, USA; Le Bonheur Neuroscience Institute, Le Bonheur Children's Hospital, 848 Adams Avenue, Memphis, TN 38103, USA; Division of Neurosurgery, St. Jude's Children's Hospital, 262 Danny Thomas Place, Memphis, TN 38105, USA; Semmes Murphey Neurologic & Spine Institute, 6325 Humphreys Boulevard, Memphis, TN 38120, USA
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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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