Evaluation of pediatric glioma outcomes using intraoperative MRI: a multicenter cohort study
The use of intraoperative MRI (iMRI) during treatment of gliomas may increase extent of resection (EOR), decrease need for early reoperation, and increase progression-free and overall survival, but has not been fully validated, particularly in the pediatric population.
To assess the accuracy of iMRI to identify residual tumor in pediatric patients with glioma and determine the effect of iMRI on decisions for resection, complication rates, and other outcomes.
We retrospectively analyzed a multicenter database of pediatric patients (age ≤ 18 years) who underwent resection of pathologically confirmed gliomas.
We identified 314 patients (mean age 9.7 ± 4.6 years) with mean follow-up of 48.3 ± 33.6 months (range 0.03–182.07 months) who underwent surgery with iMRI. There were 201 (64.0%) WHO grade I tumors, 57 (18.2%) grade II, 24 (7.6%) grade III, 9 (2.9%) grade IV, and 23 (7.3%) not classified. Among 280 patients who underwent resection using iMRI, 131 (46.8%) had some residual tumor and underwent additional resection after the first iMRI. Of the 33 tissue specimens sent for pathological analysis after iMRI, 29 (87.9%) showed positive tumor pathology. Gross total resection was identified in 156 patients (55.7%), but this was limited by 69 (24.6%) patients with unknown EOR.
Analysis of the largest multicenter database of pediatric gliomas resected using iMRI demonstrated additional tumor resection in a substantial portion of cases. However, determining the impact of iMRI on EOR and outcomes remains challenging because iMRI use varies among providers nationally. Continued refinement of iMRI techniques for use in pediatric patients with glioma may improve outcomes.
KeywordsIntraoperative MRI iMRI Glioma Pediatric Outcome Extent of resection World Health of Organization WHO grade
The authors thank Kristin Kraus, M.Sc., for her editorial assistance.
Funding for establishment and maintenance of the IMRIS iMRI Neurosurgery Database (I-MiND) was provided in part by an unrestricted educational grant from IMRIS, Inc (Minnetonka, MN) and individual participating institutions.
- 12.Kaya S, Deniz S, Duz B, Daneyemez M, Gonul E (2012) Use of an ultra-low field intraoperative MRI system for pediatric brain tumor cases: initial experience with ‘PoleStar N20’. Turk Neurosurg 22(2):218–225Google Scholar
- 16.Schwartz TH, Stieg PE, Anand VK. Endoscopic transsphenoidal pituitary surgery with intraoperative magnetic resonance imaging. Neurosurgery. 2006;58(1 Suppl):ONS44-51; discussion ONS44-51.Google Scholar
- 19.Chen LF, Yang Y, Ma XD et al (2017) Optimizing the extent of resection and minimizing the morbidity in insular high-grade glioma surgery by high-field intraoperative MRI guidance. Turk Neurosurg 27(5):696–706Google Scholar
- 20.Coburger J, Wirtz CR, Konig RW (2017) Impact of extent of resection and recurrent surgery on clinical outcome and overall survival in a consecutive series of 170 patients for glioblastoma in intraoperative high field magnetic resonance imaging. J Neurosurg Sci 61(3):233–244Google Scholar
- 22.Jenkinson MD, Barone DG, Bryant A et al (2018) Intraoperative imaging technology to maximise extent of resection for glioma. Cochrane Database Syst Rev 1:CD012788Google Scholar
- 26.Nickel K, Renovanz M, Konig J et al (2018) The patients’ view: impact of the extent of resection, intraoperative imaging, and awake surgery on health-related quality of life in high-grade glioma patients-results of a multicenter cross-sectional study. Neurosurg Rev 41(1):207–219CrossRefGoogle Scholar
- 28.Suero Molina E, Schipmann S, Stummer W. Maximizing safe resections: the roles of 5-aminolevulinic acid and intraoperative MR imaging in glioma surgery-review of the literature. Neurosurg Rev 2017Google Scholar
- 37.Yousaf J, Avula S, Abernethy LJ, Mallucci CL (2012) Importance of intraoperative magnetic resonance imaging for pediatric brain tumor surgery. Surg Neurol Int 3(Suppl 2):S65–S72Google Scholar