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The role of early intra-operative MRI in partial resection of optic pathway/hypothalamic gliomas in children

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Abstract

Introduction

Optic pathway/hypothalamic gliomas (OPHGs) are generally benign but situated in an exquisitely sensitive brain region. They follow an unpredictable course and are usually impossible to resect completely. We present a case series of 10 patients who underwent surgery for OPHGs with the aid of intra-operative MRI (ioMRI). The impact of ioMRI on OPHG resection is presented, and a role for ioMRI in partial resection is discussed.

Methods

Ten patients with OPHGs managed surgically utilising ioMRI at Alder Hey Children’s Hospital between 2010 and 2013 were retrospectively identified. Demographic and relevant clinical data were obtained.

MRI was used to estimate tumour volume pre-operatively and post-resection. If ioMRI demonstrated that further resection was possible, second-look surgery, at the discretion of the operating surgeon, was performed, followed by post-operative imaging to establish the final status of resection. Tumour volume was estimated for each MR image using the MRIcron software package.

Results

Control of tumour progression was achieved in all patients. Seven patients had, on table, second-look surgery with significant further tumour resection following ioMRI without any surgically related mortality or morbidity. The median additional quantity of tumour removed following second-look surgery, as a percentage of the initial total volume, was 27.79 % (range 11.2–59.2 %). The final tumour volume remaining with second-look surgery was 23.96 vs. 33.21 % without (p = 0.1).

Conclusions

OPHGs are technically difficult to resect due to their eloquent location, making them suitable for debulking resection only. IoMRI allows surgical goals to be reassessed intra-operatively following primary resection. Second-look surgery can be performed if possible and necessary and allows significant quantities of extra tumour to be resected safely. Although the clinical significance of additional tumour resection is not yet clear, we suggest that ioMRI is a safe and useful additional tool, to be combined with advanced neuronavigation techniques for partial tumour resection.

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Conflict of interest

The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

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Authors and Affiliations

  1. Neurosurgery Department, Alder Hey Children’s NHS Foundation Trust, Eaton Road, Liverpool, L12 2AP, UK

    Christopher Paul Millward, Sandra Perez Da Rosa, Shivaram Avula, Jonathan R. Ellenbogen, Mo Didi & Conor Mallucci

  2. Pediatric Neurosurgery Department, Carlos Haya Hospital, University of Málaga, Avenida Carlos Haya, 29010, Málaga, Spain

    Sandra Perez Da Rosa

  3. Centre for Vision Speech and Signal Processing, Department of Electronic Engineering, University of Surrey, Guildford, Surrey, GU2 7XH, UK

    Michaela Spiteri & Emma Lewis

Authors
  1. Christopher Paul Millward
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  2. Sandra Perez Da Rosa
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  3. Shivaram Avula
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  8. Conor Mallucci
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Correspondence to Christopher Paul Millward.

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Millward, C.P., Da Rosa, S.P., Avula, S. et al. The role of early intra-operative MRI in partial resection of optic pathway/hypothalamic gliomas in children. Childs Nerv Syst 31, 2055–2062 (2015). https://doi.org/10.1007/s00381-015-2830-3

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  • DOI: https://doi.org/10.1007/s00381-015-2830-3

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