Hall W A, Martin A J, Liu H, Pozza C H, Casey S O, Michel E, Nussbaum E S, Maxwell R E, Truwit C L
Department of Neurosurgery, University of Minnesota School of Medicine, Minneapolis, USA.
Pediatr Neurosurg. 1998 Nov;29(5):253-9. doi: 10.1159/000028732.
Interventional magnetic resonance (MR) imaging allows neurosurgeons to interactively perform surgery using MR guidance. High-field (1.5-Tesla) strength imaging provides exceptional visualization of intracranial and spinal pathology. The full capabilities of this technology for pediatric neurosurgery have not been defined or determined.
From January 1997 through June 1998, 10 of 85 cases performed in the interventional MR unit were in the pediatric population (mean age 8.3, median 8, range 2-15 years). Procedures included 2 brain biopsies, 5 craniotomies for tumor, 2 thoracic laminectomies for syringomyelia, and placement of a reservoir into a cystic brainstem tumor. The biopsies and reservoir placement were performed using MR-compatible equipment. Craniotomies and spinal surgery were performed with conventional instrumentation outside the 5-Gauss magnetic footprint. Interactive and intraoperative imaging was performed to assess the goals of surgery.
Both brain biopsies were diagnostic for cerebral infarct and anaplastic astrocytoma and the reservoir was optimally placed within the tumor cyst. Of the 5 tumor resections, all were considered radiographically complete. One biopsy patient and 1 tumor resection patient experienced transient neurological deficits after surgery. The patient with the thoracic syrinx required reoperation when the syringosubarachnoid shunt migrated into the syrinx 3 months after initial placement. No patient sustained a postoperative hemorrhage. Tumor histologies found at craniotomy were craniopharyngioma, ganglioglioma, and 3 low-grade gliomas. No evidence of tumor progression has been seen in any of these patients at a mean follow-up of 5.3 (range 4-8) months. The goals of the procedure were achieved in all 10 cases. There were no untoward events experienced related to MR-compatible instrumentation or intraoperative patient monitoring, despite the present inability to monitor core body temperature.
1.5-Tesla interventional MR is a safe and effective technology for assisting neurosurgeons to achieve the goals of pediatric neurosurgery. Preliminary results suggest that surgical resection of histologically benign tumors is enhanced in the interventional MR unit. The incidence of surgically related morbidity is low.
介入性磁共振（MR）成像使神经外科医生能够在MR引导下交互式地进行手术。高场强（1.5特斯拉）成像能出色地显示颅内和脊柱病变。这项技术在小儿神经外科的全部能力尚未明确或确定。
1997年1月至1998年6月，介入性MR单元所进行的85例手术中有10例为儿科患者（平均年龄8.3岁，中位数8岁，范围2 - 15岁）。手术包括2例脑活检、5例肿瘤开颅手术、2例因脊髓空洞症行胸椎椎板切除术以及在1例囊性脑干肿瘤中置入储液囊。活检和储液囊置入使用了与MR兼容的设备。开颅手术和脊柱手术在5高斯磁场范围外使用传统器械进行。进行交互式和术中成像以评估手术目标。
2例脑活检均诊断为脑梗死和间变性星形细胞瘤，储液囊最佳地放置在肿瘤囊肿内。5例肿瘤切除术在影像学上均被认为完整切除。1例活检患者和1例肿瘤切除患者术后出现短暂神经功能缺损。胸椎脊髓空洞症患者在最初置入脊髓蛛网膜下腔分流管3个月后，分流管移入脊髓空洞，需要再次手术。无患者发生术后出血。开颅手术中发现的肿瘤组织学类型为颅咽管瘤、神经节胶质瘤和3例低级别胶质瘤。在平均5.3（范围4 - 8）个月的随访中，这些患者均未出现肿瘤进展的证据。所有10例手术均实现了手术目标。尽管目前无法监测核心体温，但未发生与MR兼容器械或术中患者监测相关的不良事件。
1.5特斯拉介入性MR是一种安全有效的技术，可协助神经外科医生实现小儿神经外科手术目标。初步结果表明，在介入性MR单元中，组织学上良性肿瘤的手术切除效果得到增强。手术相关并发症的发生率较低。
