gms | German Medical Science

Objective: The use of high field intraoperative magnetic resonance imaging (iMRI) utility has been largely evaluated for the treatment of sellar lesions in adult patients. In this study we investigate the safety, advantages and limitations of high field iMRI for the treatment of craniopharyngiomas in pediatric age.

Methods: We analyzed 15 patients under 16 years of age affected by craniopharyngioma (22 surgeries). All patients were operated using iMRI (BrainSuite 1.5T). Pre- and postoperative neurological and endocrinological status, presence of residual tumor, number of intraoperative scans and complications were evaluated.

Results: The most common preoperative symptoms and signs were visual field deficit, hypophysial-hypothalamic dysfunction and intracranial hypertension. Of the 22 surgeries, 9 cases underwent the first surgery while 13 who suffered from recurrence had previous surgery. Regarding the 9 patients operated for the first time, a total removal of the lesion has been preoperatively planned and could be achieved in all cases. Considering the 13 procedures with recurrent tumors we could achieve a total removal in 10 and subtotal in 3 cases. In the 10 cases that underwent complete resection, 7 needed only 1 iMRI imaging that confirmed the total excision while residual tumor was detected in the other 3 cases at the iMRI imaging and required further removal. We had no intra- or postoperative complications due to the use of iMRI.

Conclusion: Use of iMRI for the treatment of pediatric craniopharyngiomas proved to be safe and effective in achieving complete tumor resection. We had no complications due to intraoperative imaging. The most important drawback of high-field iMRI was the difficult operative positioning, especially in younger children, due to the structure of the surgical table.