Kubben P L, van Santbrink H, ter Laak-Poort M, Weber J W, Vles J S H, Granzen B, van Overbeeke J J, Cornips E M J
Department of Neurosurgery, Maastricht University Medical Center, PO Box 5800, 6202 AZ Maastricht, the Netherlands.
Childs Nerv Syst. 2012 Aug;28(8):1171-80. doi: 10.1007/s00381-012-1815-8. Epub 2012 Jun 10.
We analyze our preliminary experience using the PoleStar N20 mobile intraoperative MR (iMR) system as an adjunct for pediatric brain tumor resection.
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.
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.
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.
我们分析了使用北极星N20移动术中磁共振（iMR）系统作为小儿脑肿瘤切除术辅助手段的初步经验。
我们分析了9名年龄在1个月至17岁之间儿童的11例切除术。切除术后，我们进行了iMR扫描以检测残留肿瘤并更新神经导航。我们将神经外科医生对最终iMR的解读与神经放射科医生对术后早期MR的解读进行了比较。
患者定位简单直接，所有病例的图像质量（T1 7分钟4毫米序列）均足够。在5例病例中，切除术后初始iMR图像上发现了疑似残留肿瘤的对比增强。1例病例中，3个月后术后成像的轻微差异在1年后不再可见。除了2例出现短暂肩部疼痛外，未遇到与北极星N20相关的严重围手术期不良事件。
对于各年龄段儿童的幕上和幕下肿瘤切除术，使用北极星N20 iMR系统在技术上是可行且安全的。他们较小的头部和肩部有利于在磁体孔中定位，并使视野覆盖超过主要感兴趣区域，例如幕下病例中的脑室。可以使用标准手术设备，且没有明显限制。在本系列中，iMR的使用在45%的病例中导致肿瘤切除范围增加。如果图像质量最佳且由熟悉该系统的人员仔细解读，iMR与术后早期MR之间的相关性非常好。
