Current aspects of intraoperative high field (3 Tesla) magnetic resonance imaging in pediatric neurosurgery: Experiences from a recently launched unit at a tertiary referral center.

To evaluate the neurosurgical and economical effectiveness of a newly launched intraoperative high field (3-Tesla) magnetic resonance MR imaging suite for pediatric tumor and epilepsy neurosurgery. Altogether, 148 procedures for 124 pediatric patients (mean age 8.7 years, range 0 - 18 years) within a 2.5-year periode were undertaken in a two- room intraoperative MRI (iopMRI) suite. Surgeries were mainly performed for intractable epilepsy (n=81, 55%) or pediatric brain tumors (n=65, 44%) in supine (n=113, 76%) and prone (n=35, 24%) position. The mean time of iopMRI imaging from draping to re-surgery was 50 minutes. IopMRI was applied not in all, but 64 out of 148 procedures (43%), in 45 procedures (31%) iopMRI was estimated unnecessary at the end of surgery based on the leading surgeons decision. In the remaining 39 procedures (26%), ultra-early postoperative MRI was carried out after closure with the patient still sterile in the head coil. Out of the 64 procedures with an iopMRI, a second look surgery was performed in 26% (in epilepsy surgery in 17%, in tumor surgery in 9%). We did not encounter any infections, wound revisions or neither position nor anesthesiologic related complications. We used intraoperative MRI imaging in less than half of pediatric tumor and epilepsy surgeries for which it was scheduled initially. Therefore, high costs argue against a routine employment in pediatric neurosurgery although it optimized surgical results in one quarter of the cases and fulfilled high safty standards.

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