Anna Lorenzen1, Samuel Groeschel1, Ulrike Ernemann2, Marko Wilke3, Martin U Schuhmann4. 1. Department of Pediatric Neurology and Developmental Medicine, Experimental Pediatric NeuroImaging, University Children's Hospital Tübingen, Hoppe-Seyler-Str. 1, 72076, Tübingen, Germany. 2. Department of Diagnostic and Interventional Neuroradiology, University Hospital Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany. 3. Department of Pediatric Neurology and Developmental Medicine, Experimental Pediatric NeuroImaging, University Children's Hospital Tübingen, Hoppe-Seyler-Str. 1, 72076, Tübingen, Germany. Marko.Wilke@med.uni-tuebingen.de. 4. Division of Pediatric Neurosurgery, Department of Neurosurgery, University Hospital Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany.
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.
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.
Authors: Hillary Shurtleff; Molly Warner; Andrew Poliakov; Brian Bournival; Dennis W Shaw; Gisele Ishak; Tong Yang; Mahesh Karandikar; Russell P Saneto; Samuel R Browd; Jeffrey G Ojemann Journal: J Neurosurg Pediatr Date: 2010-05 Impact factor: 2.375
Authors: W D Gaillard; L Balsamo; B Xu; C McKinney; P H Papero; S Weinstein; J Conry; P L Pearl; B Sachs; S Sato; L G Vezina; C Frattali; W H Theodore Journal: Neurology Date: 2004-10-26 Impact factor: 9.910
Authors: Lorenzo Bello; Anna Gambini; Antonella Castellano; Giorgio Carrabba; Francesco Acerbi; Enrica Fava; Carlo Giussani; Marcello Cadioli; Valeria Blasi; Alessandra Casarotti; Costanza Papagno; Arun K Gupta; Sergio Gaini; Giuseppe Scotti; Andrea Falini Journal: Neuroimage Date: 2007-08-29 Impact factor: 6.556