Abstract
From its inception intraoperative magnetic resonance imaging (ioMRI) was envisioned to have significant applications in neurosurgery in general and pediatrics specifically. Over the last 9 years we have noted a dramatic shift in our ioMRI usage from intracranial tumors to cerebrospinal fluid management and complex cysts. Here we present seven selected cases to illustrate lessons learned from our operative experience within the GE Signa SP/I open-configuration “double-doughnut” MRI. These cases including a ganglioglioma, ependymoma, and pilocytic astrocytoma tumor resection, as well as arachnoid cysts, complex cyst, and microabscess drainage reflect our current use of ioMRI in pediatric neurosurgical cases. Namely that ioMRI is optimal for (1) resection of small tumors with poorly differentiated tumor margins, (2) large tumors with mass effect, and (3) shunt or catheter placement requiring either extreme accuracy or intraoperative confirmation of catheter placement. We also comment on the legitimate limitations of this technology in certain operations. Additionally emphasized are cases in which ioMRI imaging drives operative decision making, highlighting the unique and unequaled abilities of this technology for a subset of pediatric neurosurgical cases.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Black PM, Moriarty T, Alexander E, Stieg P, Woodard EJ, Gleason PL, Martin CH, Kikinis R, Schwartz RB, Jolesz FA (1997) Development and implementation of intraoperative magnetic resonance imaging and its neurosurgical applications. Neurosurgery 41:831–842, Discussion 842–845
Tronnier VM, Wirtz CR, Knauth M, Lenz G, Pastyr O, Bonsanto MM, Albert FK, Kuth R, Staubert A, Schlegel W, Sartor K, Kunze S (1997) Intraoperative diagnostic and interventional magnetic resonance imaging in neurosurgery. Neurosurgery 40:891–900, Discussion 900–902
Schulder M, Jacobs A, Carmel PW (2001) Intraoperative MRI and adjuvant radiosurgery. Stereotact Funct Neurosurg 76:151–158
Hall WA, Martin AJ, Liu H, Pozza CH, Casey SO, Michel E, Nussbaum ES, Maxwell RE, Truwit CL (1998) High-field strength interventional magnetic resonance imaging for pediatric neurosurgery. Pediatr Neurosurg 29:253–259
Sutherland GR, Louw DF (1999) Intraoperative MRI: a moving magnet. CMAJ 161:1293
Mutchnick IS, Moriarty TM (2005) Neurosurgical uses for intraprocedural magnetic resonance imaging. Top Magn Reson Imaging 16:383–395
Shaw EG, Berkey B, Coons SW, Bullard D, Brachman D, Buckner JC, Stelzer KJ, Barger GR, Brown PD, Gilbert MR, Mehta M (2008) Recurrence following neurosurgeon-determined gross-total resection of adult supratentorial low-grade glioma: results of a prospective clinical trial. J Neurosurg 109:835–841
Talos IF, Zou KH, Ohno-Machado L, Bhagwat JG, Kikinis R, Black PM, Jolesz FA (2006) Supratentorial low-grade glioma resectability: statistical predictive analysis based on anatomic MR features and tumor characteristics. Radiology 239:506–513
Claus EB, Horlacher A, Hsu L, Schwartz RB, Dello-Iacono D, Talos F, Jolesz FA, Black PM (2005) Survival rates in patients with low-grade glioma after intraoperative magnetic resonance image guidance. Cancer 103:1227–1233
Maksoud YA, Hahn YS, Engelhard HH (2002) Intracranial ependymoma. Neurosurg Focus 13:e4
Robertson PL, Zeltzer PM, Boyett JM, Rorke LB, Allen JC, Geyer JR, Stanley P, Li H, Albright AL, McGuire-Cullen P, Finlay JL, Stevens KR Jr, Milstein JM, Packer RJ, Wisoff J (1998) Survival and prognostic factors following radiation therapy and chemotherapy for ependymomas in children: a report of the Children’s Cancer Group. J Neurosurg 88:695–703
Gunny RS, Hayward RD, Phipps KP, Harding BN, Saunders DE (2005) Spontaneous regression of residual low-grade cerebellar pilocytic astrocytomas in children. Pediatr Radiol 35:1086–1091
Schulder M, Sernas TJ, Carmel PW (2003) Cranial surgery and navigation with a compact intraoperative MRI system. Acta Neurochir Suppl 85:79–86
Moriarty TM, Quinones-Hinojosa A, Larson PS, Alexander E 3rd, Gleason PL, Schwartz RB, Jolesz FA, Black PM (2000) Frameless stereotactic neurosurgery using intraoperative magnetic resonance imaging: stereotactic brain biopsy. Neurosurgery 47:1138–1145, discussion 1145–1146
Moriarty TM, Kikinis R, Jolesz FA, Black PM, Alexander E 3rd (1996) Magnetic resonance imaging therapy. Intraoperative MR imaging. Neurosurg Clin N Am 7:323–331
Schenck JF, Jolesz FA, Roemer PB, Cline HE, Lorensen WE, Kikinis R, Silverman SG, Hardy CJ, Barber WD, Laskaris ET et al (1995) Superconducting open-configuration MR imaging system for image-guided therapy. Radiology 195:805–814
Vitaz TW, Hushek S, Shields CB, Moriarty T (2003) Intraoperative MRI for pediatric tumor management. Acta Neurochir Suppl 85:73–78
Woodard EJ, Leon SP, Moriarty TM, Quinones A, Zamani AA, Jolesz FA (2001) Initial experience with intraoperative magnetic resonance imaging in spine surgery. Spine 26:410–417
Jolesz FA (2005) Future perspectives for intraoperative MRI. Neurosurg Clin N Am 16:201–213
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2011 Springer-Verlag/Wien
About this chapter
Cite this chapter
Moriarty, T.M., Titsworth, W.L. (2011). The Evolution of iMRI Utilization for Pediatric Neurosurgery: A Single Center Experience. In: Pamir, M., Seifert, V., Kiris, T. (eds) Intraoperative Imaging. Acta Neurochirurgica Supplementum, vol 109. Springer, Vienna. https://doi.org/10.1007/978-3-211-99651-5_14
Download citation
DOI: https://doi.org/10.1007/978-3-211-99651-5_14
Published:
Publisher Name: Springer, Vienna
Print ISBN: 978-3-211-99650-8
Online ISBN: 978-3-211-99651-5
eBook Packages: MedicineMedicine (R0)