Intra-operative MRI-guided approaches to the pediatric posterior fossa tumors.
BACKGROUND
The posterior fossa in a child poses a considerable challenge to the neurosurgeon. MRI-guided surgery allows for real time interaction between imaging and the neurosurgeon, not permitted by frameless stereotaxy, and with higher resolution than ultrasound or CT.


METHODS
The University of Minnesota 1.5 T Phillips interventional MRI was used. From 1997 to 2000, nine posterior fossa intraoperative magnet cases out of eleven were pediatric. The mean age was 6.4 years and the median age 7. Seven midline craniotomies were performed, of which three were re-operations. Two were burr hole placements, one for cyst aspiration and P32 instillation, and the other for tumor biopsy.


RESULTS
Two tumors were predominantly in the fourth ventricle, four in the cerebellum, two in the brainstem, and one in the prepontine cystern. Four tumors were juvenile pilocytic astrocytomas, two were anaplastic astrocytomas, and one each was ependymoma, craniopharyngioma cyst, and medulloblastoma. Four patients had complete radiologic resection. Two had maximal resections limited by vital structures. P32 instillation and tumor biopsy were done in a single pass. Follow-up ranged from 3 months to 1.4 years. The cyst that was aspirated and had P32 instillation remains absent. The two mortalities were in the patients with medulloblastoma and anaplastic astrocytoma. There were no intra-operative mortalities. The other patient with anaplastic astrocytoma progressed. The remainder had stable imaging.


CONCLUSIONS
MRI-guided surgery results in improved resection imaging and real-time needle guidance in tumor operations. Its value could lie in low-grade lesions, where maximal resection is most beneficial.
Lam
C H
CH
Department of Neurosurgery, University of Minnesota, Minneapolis, MN, USA. lamxx023@tcn.umn.edu
Hall
W A
WA
Truwit
C L
CL
Liu
H
H
D002648:Child; D002675:Child, Preschool; D003388:Cranial Fossa, Posterior / Q000473:pathology / Q000601:surgery*; D005260:Female; D005910:Glioma / Q000473:pathology / Q000601:surgery*; D006801:Humans; D015192:Infratentorial Neoplasms / Q000473:pathology / Q000601:surgery*; D007432:Intraoperative Period; D008279:Magnetic Resonance Imaging; D008297:Male; D016896:Treatment Outcome