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Role of presurgical functional MRI and diffusion MR tractography in pediatric low-grade brain tumor surgery: a single-center study

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Abstract

Purpose

Presurgical functional MRI (fMRI) and diffusion MRI tractography (dMRI tractography) are widely employed to delineate eloquent brain regions and their connections prior to brain tumor resection in adults. However, such studies are harder to perform in children, resulting in suboptimal neurosurgical care in pediatric brain tumor surgery as compared to adults. Thus, our objective was to assess the feasibility and the influence of presurgical advanced MR imaging on neurosurgical care in pediatric brain tumor surgery.

Methods

Retrospective analyses of 31 presurgical fMRI/dMRI tractography studies were performed in children with low-grade tumors near eloquent brain regions at our site between 2005 and 2017.

Results

In only 3/31 cases, imaging results were not interpretable (10%). All 28 successful imaging sessions were used for neurosurgical risk assessment. Based on this, surgery was canceled in 2/28 patients, and intention to treat was changed in 5/28 patients. In 4/28 cases, the surgical approach was changed and in 10/28, electrode placement for intraoperative neurophysiological monitoring was guided by imaging results. Gross total resection (GTR) was planned in 21/28 cases and could be achieved in 15/21 (71%). Despite highly eloquent tumor location, only four children suffered from a mild permanent neurological deficit after the operation.

Conclusions

We demonstrate that presurgical fMRI/dMRI tractography can have a profound impact on pediatric brain tumor management, optimizing preoperative risk-assessment and pre- as well as intraoperative decision-making. We believe that these tools should be offered to children suffering from eloquent brain tumors as part of a comprehensive operative work-up.

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Funding

This study was funded in part by the H.W. & J. Hector Foundation, Mannheim, Germany (M66). The sponsor had no part in study design, interpretation of results, or decision to publish.

Author information

Author notes

  1. Marko Wilke and Martin U. Schuhmann contributed equally to this work.

Authors and Affiliations

  1. Department of Pediatric Neurology and Developmental Medicine, Experimental Pediatric NeuroImaging, University Children’s Hospital Tübingen, Hoppe-Seyler-Str. 1, 72076, Tübingen, Germany

    Anna Lorenzen, Samuel Groeschel & Marko Wilke

  2. Department of Diagnostic and Interventional Neuroradiology, University Hospital Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany

    Ulrike Ernemann

  3. Division of Pediatric Neurosurgery, Department of Neurosurgery, University Hospital Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany

    Martin U. Schuhmann

Authors
  1. Anna Lorenzen
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  4. Marko Wilke
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Corresponding author

Correspondence to Marko Wilke.

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Conflict of interest

None of the authors has any conflict of interest to disclose.

Ethical approval

All procedures performed were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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All caregivers provided informed consent.

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Cite this article

Lorenzen, A., Groeschel, S., Ernemann, U. et al. Role of presurgical functional MRI and diffusion MR tractography in pediatric low-grade brain tumor surgery: a single-center study. Childs Nerv Syst 34, 2241–2248 (2018). https://doi.org/10.1007/s00381-018-3828-4

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  • DOI: https://doi.org/10.1007/s00381-018-3828-4

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