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66th Annual Meeting of the German Society of Neurosurgery (DGNC)
Friendship Meeting with the Italian Society of Neurosurgery (SINch)

German Society of Neurosurgery (DGNC)

7 - 10 June 2015, Karlsruhe

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Use of intraoperative magnetic resonance in pediatric neurosurgery: our experience

Meeting Abstract

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  • Mario Giordano - Neurosurgery, International Neuroscience Institute (INI), Hannover
  • Concezio Di Rocco - Istituto di Neurochirurgia, U.C.S.C. Policlinico Universitario A. Gemelli, Roma, Italy
  • Wolf Lüdemann - Neurosurgery, International Neuroscience Institute (INI), Hannover
  • Rudolf Fahlbusch - Neurosurgery, International Neuroscience Institute (INI), Hannover
  • Amir Samii - Neurosurgery, International Neuroscience Institute (INI), Hannover
  • Madjid Samii - Neurosurgery, International Neuroscience Institute (INI), Hannover

Deutsche Gesellschaft für Neurochirurgie. 66. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC). Karlsruhe, 07.-10.06.2015. Düsseldorf: German Medical Science GMS Publishing House; 2015. DocDI.16.06

doi: 10.3205/15dgnc183, urn:nbn:de:0183-15dgnc1835

Published: June 2, 2015

© 2015 Giordano et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Objective: The introduction of high-field intraoperative magnetic resonance imaging (iMRI) has been an important innovation in the surgical treatment of intracranial tumors. While many reports have dealt with this technique applied in adult patients, few information is available concerning the pediatric population. In this study we investigate the feasibility, advantages and limitations of high-field iMRI for cranial neurosurgical procedures in pediatric population.

Method: Since its availability in our institute in 2007, we've treated 1,103 patients using iMRI. Out of these patients, 81 were children under 16 years of age. Mean age 7.4 years, (44 female, 37 male). Tumor location, histology, surgical positioning and approach, presence of residual tumor, number of intraoperative scans and complications were evaluated.

Results: Supratentorial tumors were the most common lesions (70 cases, 86.4%) in the population here considered with gliomas (25 cases, 30.9%) and craniopharyngiomas (22 cases, 27.2%) being the largest groups. Transsphenoidal, frontotemporal and interhemisferic approach were the most used. Sixty-three procedures (77.8%) were performed with patients lying in supine and 18 in prone position (22.2%). Average number of scans per patient was 1.3 (min. 1, max 4). There was no imaging-related complication and/or depending on the longer duration of the procedure. The first intraoperative scans resulted in further tumor resection in 19 (23.5%) cases. In 17 (21%) patients the surgery was ended after a second MRI, in one case (1.2%) a third control was necessary and in another case a fourth MRI was performed.

Conclusions: The use of iMRI in the pediatric population is safe and the limitations are mostly due to the configuration of the surgical table. The application of this technique allowed further tumor resection in almost one fourth of the cases. The disadvantage of the prolonged surgical time is balanced by the fact that younger children don't need a new sedation for postoperative MRI.