Giordano Mario, Samii Amir, Lawson McLean Anna C, Bertalanffy Helmut, Fahlbusch Rudolf, Samii Madjid, Di Rocco Concezio
Department of Neurosurgery, International Neuroscience Institute, Hannover; and.
Leibniz Institute for Neurobiology, Magdeburg, Germany.
J Neurosurg Pediatr. 2017 Jan;19(1):77-84. doi: 10.3171/2016.8.PEDS15708. Epub 2016 Oct 28.
OBJECTIVE The use of high-field intraoperative MRI has been largely studied for the treatment of intracranial tumors in adult patients. In this study, the authors investigated the safety, advantages, and limitations of high-field iMRI for cranial neurosurgical procedures in pediatric patients, with particular attention to craniopharyngiomas and gliomas. METHODS The authors performed 82 surgical procedures in patients under 16 years of age (range 0.8-15 years) over an 8-year period (2007-2014) using iMRI. The population was divided into 3 groups based on the condition treated: sellar region tumors (Group 1), gliomas (Group 2), and other pathological entities (Group 3). The patients' pre- and postoperative neurological status, the presence of residual tumor, the number of intraoperative scans, and complications were evaluated. RESULTS In Group 1, gross-total resection (GTR) was performed in 22 (88%) of the procedures and subtotal resection (STR) in 3 (12%). In Group 2, GTR, STR, and partial resection (PR) were performed, respectively, in 15 (56%), 7 (26%), and 5 (18%) of the procedures. In Group 3, GTR was performed in 28 (93%) and STR in 2 (7%) of the procedures. In cases of craniopharyngioma (Group 1) and glioma (Group 2) in which a complete removal was planned, iMRI allowed localization of residual lesions and attainment of the surgical goal through further resection, respectively, in 18% and 27% of the procedures. Moreover, in gliomas the resection could be extended from partial to subtotal in 50% of the cases. In 17% of the patients in Group 3, iMRI enabled the identification and further removal of tumor remnants. There was no intra- or postoperative complication related to the use of iMRI despite special technical difficulties in smaller children. CONCLUSIONS In this study, the use of iMRI in children proved to be safe. It was most effective in increasing the extent of tumor resection, especially in patients with low-grade gliomas and craniopharyngiomas. The most prominent disadvantage of high-field iMRI was the limitation with respect to operative positioning due to the configuration of the surgical table.
目的 高场术中磁共振成像（iMRI）在成年患者颅内肿瘤治疗中的应用已得到广泛研究。在本研究中，作者调查了高场iMRI在小儿患者颅脑神经外科手术中的安全性、优势及局限性，尤其关注颅咽管瘤和胶质瘤。方法 在8年期间（2007 - 2014年），作者使用iMRI对16岁以下（年龄范围0.8 - 15岁）的患者进行了82例外科手术。根据治疗疾病将患者分为3组：鞍区肿瘤（第1组）、胶质瘤（第2组）和其他病理实体（第3组）。评估患者术前和术后的神经状态、残余肿瘤的存在情况、术中扫描次数及并发症。结果 在第1组中，22例（88%）手术实现了全切除（GTR），3例（12%）为次全切除（STR）。在第2组中，分别有15例（56%）、7例（26%）和5例（18%）手术进行了GTR、STR和部分切除（PR）。在第3组中，28例（93%）手术进行了GTR，2例（7%）为STR。在计划完全切除的颅咽管瘤（第1组）和胶质瘤（第2组）病例中，iMRI分别在18%和27%的手术中允许定位残余病变并通过进一步切除实现手术目标。此外，在胶质瘤中，50%的病例切除范围可从部分切除扩展至次全切除。在第3组17%的患者中，iMRI能够识别并进一步切除肿瘤残余。尽管在较小儿童中存在特殊技术困难，但未出现与使用iMRI相关的术中或术后并发症。结论 在本研究中，iMRI在儿童中的应用被证明是安全的。它在增加肿瘤切除范围方面最有效，尤其是在低级别胶质瘤和颅咽管瘤患者中。高场iMRI最突出的缺点是由于手术台的配置在手术定位方面存在局限性。
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