title: 3T intraoperative MRI for management of pediatric CNS neoplasms.
abstract: OBJECTIVE
  High-field-strength intraoperative MR imaging has emerged as a powerful adjunct for resection of brain tumors. However, its exact role has not been firmly established. We sought to determine the impact of 3T-intraoperative MRI on the surgical management of childhood CNS tumors.
  
  
  METHODS
  We evaluated patient data from a single academic children's hospital during a consecutive 24-month period after installation of a 3T-intraoperative MRI. Tumor location, histology, surgical approach, operating room time, presence and volume of residual tumor, need for tumor and non-tumor-related reoperation, and anesthesia- and MR imaging-related complications were evaluated. Comparison with pre-intraoperative MRI controls was performed.
  
  
  RESULTS
  One hundred ninety-four patients underwent intraoperative MRI-guided surgery. Of these, 168 were 18 years or younger (mean, 8.9 ± 5.0 years; 108 males/60 females). There were 65 posterior fossa tumors. The most common tumors were pilocytic astrocytoma (n = 31, 19%), low-grade glioma (n = 31, 19%), and medulloblastoma (n = 20, 12%). An average of 1.2 scanning sessions was performed per patient (maximum, 3). There were no MR imaging-related safety issues. Additional tumor was resected after scanning in 21% of patients. Among patients with a preoperative goal of gross total resection, 93% achieved this goal. The 30-day reoperation rate was <1% (n = 1), and no patient required additional postoperative MR imaging during the same hospital stay.
  
  
  CONCLUSIONS
  Intraoperative MRI is safe and increases the likelihood of gross total resection, albeit with increased operating room time, and reduces the need for early reoperation or repeat sedation for postoperative scans in children with brain tumors.
authors: From the Departments of Radiology (A.F.C., M.T.W.) Neurosurgery (A.F.C., P.K., T.S.A., F.A.B.) Ophthalmology (A.F.C.), University of Tennessee Health Science Center, Memphis, Tennessee Le Bonheur Neuroscience Institute (A.F.C., P.K., M.T.W., F.A.B.), Le Bonheur Children's Hospital, Memphis, Tennessee achoudhri@uthsc.edu.
authors: A F
authors: http://orcid.org/0000-0002-3154-6319
authors: AF
authors: Choudhri
authors: Neurosurgery (A.F.C., P.K., T.S.A., F.A.B.) Le Bonheur Neuroscience Institute (A.F.C., P.K., M.T.W., F.A.B.), Le Bonheur Children's Hospital, Memphis, Tennessee Semmes-Murphey Neurologic and Spine Institute (P.K., F.A.B.), Memphis, Tennessee Division of Neurosurgery (P.K., F.A.B.), and Department of Surgery, St. Jude Children's Hospital, Memphis, Tennessee.
authors: P
authors: P
authors: Klimo
authors: Neurosurgery (A.F.C., P.K., T.S.A., F.A.B.).
authors: T S
authors: TS
authors: Auschwitz
authors: From the Departments of Radiology (A.F.C., M.T.W.) Le Bonheur Neuroscience Institute (A.F.C., P.K., M.T.W., F.A.B.), Le Bonheur Children's Hospital, Memphis, Tennessee Department of Radiology (M.T.W.), Children's National Medical Center, Washington, DC.
authors: M T
authors: MT
authors: Whitehead
authors: Neurosurgery (A.F.C., P.K., T.S.A., F.A.B.) Le Bonheur Neuroscience Institute (A.F.C., P.K., M.T.W., F.A.B.), Le Bonheur Children's Hospital, Memphis, Tennessee Semmes-Murphey Neurologic and Spine Institute (P.K., F.A.B.), Memphis, Tennessee Division of Neurosurgery (P.K., F.A.B.), and Department of Surgery, St. Jude Children's Hospital, Memphis, Tennessee.
authors: F A
authors: FA
authors: Boop
mesh_terms: D000293:Adolescent; D001932:Brain Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005910:Glioma / Q000473:pathology; D006801:Humans; D007223:Infant; D053783:Magnetic Resonance Imaging, Interventional / Q000379:methods*; D008297:Male; D018365:Neoplasm, Residual / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D025321:Surgery, Computer-Assisted / Q000379:methods*