Giordano Mario, Arraez Cinta, Samii Amir, Samii Madjid, Di Rocco Concezio
Department of Neurosurgery, International Neuroscience Institute, Rudolf Pichlmayr Str. 4, 30625, Hannover, Germany.
Childs Nerv Syst. 2016 Oct;32(10):1915-22. doi: 10.1007/s00381-016-3177-0. Epub 2016 Sep 20.
The treatment of low-grade gliomas (LGGs) in pediatric age is still controversial. However, most authors report longer life expectancy in case of completely removed cerebral gliomas. Intraoperative magnetic resonance imaging (iMRI) is increasingly utilized in the surgical management of intra-axial tumor in adults following the demonstration of its effectiveness. In this article, we analyze the management of LGG using iMRI focusing on its impact on resection rate and its limits in the pediatric population.
We performed review of the literature regarding the treatment of LGG using iMRI focusing on its impact on resection rate and its limits in the pediatric population. Some exemplary cases are also described.
Intraoperative MRI allowed extension of tumor resection after the depiction of residual tumor at the intraoperative imaging control from 21 to 52 % of the cases in the published series. Moreover, the early reoperation rate was significantly lower when compared with the population treated without this tool (0 % vs 7-14 %). Some technical difficulties have been described in literature regarding the use of iMRI in the pediatric population especially for positioning due to the structure of the headrest coil designed for adult patients.
The analysis of the literature and our own experience with iMRI in children indicates significant advantages in the resection of LGG offered by the technique. All these advantages are obtained without elongation of the surgical times or increased risk for complications, namely infection. The main limit for a wider diffusion of iMRI for the pediatric neurosurgical center is the cost required, for acquisition of the system, especially for high-field magnet, and the environmental and organizational changes necessary for its use.
小儿低级别胶质瘤（LGGs）的治疗仍存在争议。然而，大多数作者报告称，脑胶质瘤完全切除的情况下患者预期寿命更长。术中磁共振成像（iMRI）在被证明有效后，越来越多地应用于成人脑内肿瘤的手术治疗。在本文中，我们分析了使用iMRI治疗LGG的情况，重点关注其对切除率的影响及其在儿科人群中的局限性。
我们对有关使用iMRI治疗LGG的文献进行了综述，重点关注其对切除率的影响及其在儿科人群中的局限性。还描述了一些典型病例。
在已发表的系列研究中，术中MRI在术中影像检查发现残留肿瘤后，使肿瘤切除范围得以扩大，从21%增至52%。此外，与未使用该工具治疗的人群相比，早期再次手术率显著降低（0%对7%-14%）。文献中描述了在儿科人群中使用iMRI存在的一些技术困难，特别是由于为成人患者设计的头枕线圈结构导致的定位问题。
对文献的分析以及我们自己在儿童中使用iMRI的经验表明，该技术在LGG切除方面具有显著优势。所有这些优势都是在不延长手术时间或增加并发症（即感染）风险的情况下获得的。iMRI在儿科神经外科中心更广泛应用的主要限制是购置系统所需的成本，特别是高场磁体的成本，以及使用它所需的环境和组织变革。
