Use of an Offsite Intraoperative MRI Operating Theater for Pediatric Brain Tumor Surgery: Experience from a Singapore Children's Hospital

Low, Sharon Yin Yee; Lim, Eileen C.P.; Loh, L.; Mok, Yee Hui; Siow, Yew Nam; Ng, Lee Ping; Seow, Wan Tew; Kirollos, Ramez; Low, David C.Y.

doi:10.1016/j.wneu.2019.10.083

Cited by 8 publications

(6 citation statements)

References 24 publications

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“…The literature search on PubMed yielded 128 articles, of which ten met our inclusion criteria ( Figure 1 ; Table 1 ) ( Abernethy et al, 2012 ; Yousaf et al, 2012 ; Avula et al, 2013 ; Ren et al, 2013 ; Giordano et al, 2017 ; Tejada et al, 2018 ; Saint-Martin et al, 2019 ; Low et al, 2020 ; Avula et al, 2021 ; Sunderland et al, 2021 ). Most of these studies were cohort studies, two were case series ( Abernethy et al, 2012 ; Ren et al, 2013 ), one included a review of experience ( Abernethy et al, 2012 ), and one included a comparison of their results to existing literature ( Low et al, 2020 ). A total of 604 ioMRI brain tumor patients were described in the included literature.…”

Section: Resultsmentioning

confidence: 99%

“…Just one study focused specifically on advanced ioMRI ( Saint-Martin et al, 2019 ) but did not perform any post-processing for further data analysis. Eight studies were evaluated as having a low risk of bias as they included consecutive patients of all histopathological brain tumors though five of these studies reported advanced imaging only in selective patients ( Abernethy et al, 2012 ; Yousaf et al, 2012 ; Avula et al, 2013 ; Tejada et al, 2018 ; Low et al, 2020 ), introducing an increased bias risk. Two studies had a higher risk of bias as they selected based on tumor type; subendymal giant cell astrocytoma ( Ren et al, 2013 ) or thalamic tumor patients ( Sunderland et al, 2021 ).…”

Section: Resultsmentioning

confidence: 99%

“…The ten articles that reported the use of advanced ioMRI sequences for pediatric brain tumor surgery focused on diffusion MRI (DWI and DTI), perfusion MRI (DSC), and metabolic MRI (MRS and CSI). Diffusion MRI was used in 288 patients, covered by seven studies ( Ren et al, 2013 ; Giordano et al, 2017 ; Tejada et al, 2018 ; Saint-Martin et al, 2019 ; Low et al, 2020 ; Avula et al, 2021 ; Sunderland et al, 2021 ). Three other studies that covered diffusion MRI did not specify the number of patients.…”

Section: Resultsmentioning

confidence: 99%

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Advanced intraoperative MRI in pediatric brain tumor surgery

et al. 2023

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Introduction: In the pediatric brain tumor surgery setting, intraoperative MRI (ioMRI) provides “real-time” imaging, allowing for evaluation of the extent of resection and detection of complications. The use of advanced MRI sequences could potentially provide additional physiological information that may aid in the preservation of healthy brain regions. This review aims to determine the added value of advanced imaging in ioMRI for pediatric brain tumor surgery compared to conventional imaging.Methods: Our systematic literature search identified relevant articles on PubMed using keywords associated with pediatrics, ioMRI, and brain tumors. The literature search was extended using the snowball technique to gather more information on advanced MRI techniques, their technical background, their use in adult ioMRI, and their use in routine pediatric brain tumor care.Results: The available literature was sparse and demonstrated that advanced sequences were used to reconstruct fibers to prevent damage to important structures, provide information on relative cerebral blood flow or abnormal metabolites, or to indicate the onset of hemorrhage or ischemic infarcts. The explorative literature search revealed developments within each advanced MRI field, such as multi-shell diffusion MRI, arterial spin labeling, and amide-proton transfer-weighted imaging, that have been studied in adult ioMRI but have not yet been applied in pediatrics. These techniques could have the potential to provide more accurate fiber tractography, information on intraoperative cerebral perfusion, and to match gadolinium-based T1w images without using a contrast agent.Conclusion: The potential added value of advanced MRI in the intraoperative setting for pediatric brain tumors is to prevent damage to important structures, to provide additional physiological or metabolic information, or to indicate the onset of postoperative changes. Current developments within various advanced ioMRI sequences are promising with regard to providing in-depth tissue information.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Advanced intraoperative MRI in pediatric brain tumor surgery

et al. 2023

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“…Shah and colleagues reported that ioMRI-guided resections for tumors reduced the need for early re-reoperation with postoperative comparable deficits versus conventional pediatric resections ( 24 ). Other published reports have concluded that ioMRI proved to be useful in reducing the final tumor volume with additional resection (range, 17%–60%) without intraoperative complications and avoiding the cost and operative risk associated with a later reoperation ( 24 – 34 ). Our results showed that in 14% of the intracranial tumor surgeries, the ioMRI provided valuable information that allowed the surgeon to proceed with further resection of remnants.…”

Section: Discussionmentioning

confidence: 96%

The impact of 1.5-T intraoperative magnetic resonance imaging in pediatric tumor surgery: Safety, utility, and challenges

et al. 2023

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ObjectiveIn 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.MethodsA 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.ResultsA 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%.ConclusionioMRI 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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“…Within the identified studies, GTR was a common goal in the iMRI-assisted paediatric neurosurgeries (Table 1). 36,37,[39][40][41][42][43][44][45][46][47][48] There were three case-control studies that compared rates of GTR in procedures with and without iMRI. 39,44,48 Sunderland et al 44 found that a significantly higher proportion of cases achieved GTR in iMRI (94.2%) compared to conventional surgeries without iMRI (37.5%).…”

Section: Rates Of Gross Total Resectionmentioning

confidence: 99%

Evaluating the use of intraoperative magnetic resonance imaging in paediatric brain tumour resection surgeries: a literature review

Wu,

Clift,

Hilliard

et al. 2023

J of Medical Radiation Sci

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Brain tumours are the most common solid neoplasm in children, posing a significant challenge in oncology due to the limited range of treatment. Intraoperative magnetic resonance imaging (iMRI) has recently emerged to aid surgical intervention in neurosurgery resection with the potential to delineate tumour boundaries. This narrative literature review aimed to provide an updated evaluation of the clinical implementation of iMRI in paediatric neurosurgical resection, with an emphasis on the extent of brain tumour resection, patient outcomes and its drawbacks. Databases including MEDLINE, PubMed, Scopus and Web of Science were used to investigate this topic with key terms: paediatric, brain tumour, and iMRI. Exclusion criteria included literature comprised of adult populations and the use of iMRI in neurosurgery in the absence of brain tumours. The limited body of research evaluating the clinical implementation of iMRI in paediatric cohorts has been predominantly positive. Current evidence demonstrates the potential for iMRI use to increase rates of gross total resection (GTR), assess the extent of resection, and improve patient outcomes, such as progression‐free survival. Limitations regarding the use of iMRI include prolonged operation times and complications associated with head immobilisation devices. iMRI has the potential to aid in the achievement of maximal brain tumour resection in paediatric patients. Future prospective randomised controlled trials are necessary to determine the clinical significance and benefits of using iMRI during neurosurgical resection for clinical management of brain neoplasms in children.

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Use of an Offsite Intraoperative MRI Operating Theater for Pediatric Brain Tumor Surgery: Experience from a Singapore Children's Hospital

Cited by 8 publications

References 24 publications

Advanced intraoperative MRI in pediatric brain tumor surgery

Advanced intraoperative MRI in pediatric brain tumor surgery

The impact of 1.5-T intraoperative magnetic resonance imaging in pediatric tumor surgery: Safety, utility, and challenges

Evaluating the use of intraoperative magnetic resonance imaging in paediatric brain tumour resection surgeries: a literature review

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