Department of Neurosurgery, Alder Hey Children's Hospital NHS Trust, Eaton Road, Liverpool, L12 2AP, UK.
Section of Pediatric Neurosurgery, Department of Neurosurgery, University Hospital of Tuebingen, Tuebingen, Germany.
Childs Nerv Syst. 2024 Oct;40(10):3165-3172. doi: 10.1007/s00381-024-06532-3. Epub 2024 Jul 16.
Pediatric low-grade gliomas (pLGG) are the most common brain tumors in children and achieving complete resection (CR) in pLGG is the most important prognostic factor. There are multiple intraoperative tools to optimize the extent of resection (EOR). This article investigates and discusses the role of intraoperative ultrasound (iUS) and intraoperative magnetic resonance imaging (iMRI) in the surgical treatment of pLGG.
The tumor registries at Tuebingen, Rome and Pretoria were searched for pLGG with the use of iUS and data on EOR. The tumor registries at Liverpool and Tuebingen were searched for pLGG with the use of iMRI where preoperative CR was the surgical intent. Different iUS and iMRI machines were used in the 4 centers.
We included 111 operations which used iUS and 182 operations using iMRI. Both modalities facilitated intended CR in hemispheric supra- and infratentorial location in almost all cases. In more deep-seated tumor location like supratentorial midline tumors, iMRI has advantages over iUS to visualize residual tumor. Functional limitations limiting CR arising from eloquent involved or neighboring brain tissue apply to both modalities in the same way. In the long-term follow-up, both iUS and iMRI show that achieving a complete resection on intraoperative imaging significantly lowers recurrence of disease (chi-square test, p < 0.01).
iUS and iMRI have specific pros and cons, but both have been proven to improve achieving CR in pLGG. Due to advances in image quality, cost- and time-efficiency, and efforts to improve the user interface, iUS has emerged as the most accessible surgical adjunct to date to aid and guide tumor resection. Since the EOR has the most important effect on long-term outcome and disease control of pLGG in most locations, we strongly recommend taking all possible efforts to use iUS in any surgery, independent of intended resection extent and iMRI if locally available.
小儿低级别胶质瘤（pLGG）是儿童中最常见的脑肿瘤，在 pLGG 中实现完全切除（CR）是最重要的预后因素。有多种术中工具可优化切除范围（EOR）。本文探讨了术中超声（iUS）和术中磁共振成像（iMRI）在 pLGG 手术治疗中的作用。
检索图宾根、罗马和比勒陀利亚的肿瘤登记处，使用 iUS 并获取有关 EOR 的数据，检索利物浦和图宾根的肿瘤登记处，使用 iMRI，术前 CR 是手术目标。这 4 个中心使用了不同的 iUS 和 iMRI 机器。
我们纳入了 111 例使用 iUS 和 182 例使用 iMRI 的手术。两种方式都有助于在半球幕上和幕下位置实现预期的 CR。在更深处的肿瘤位置，如幕上中线肿瘤，iMRI 具有优于 iUS 的优势，可显示残留肿瘤。由于涉及到功能区或邻近脑组织的功能限制，限制 CR 的因素适用于两种方式。在长期随访中，iUS 和 iMRI 均显示术中成像实现完全切除可显著降低疾病复发率（卡方检验，p<0.01）。
iUS 和 iMRI 各有优缺点，但都已被证明可提高 pLGG 的 CR 率。由于图像质量、成本和时间效率的提高，以及改善用户界面的努力，iUS 已成为迄今为止最容易获得的手术辅助手段，可帮助和指导肿瘤切除。由于 EOR 对大多数部位的 pLGG 的长期预后和疾病控制影响最大，因此我们强烈建议在任何手术中，无论预期切除范围如何，都应尽一切可能使用 iUS，并在当地有 iMRI 的情况下使用 iMRI。
