Utility and applications of high-field 1.5 T intraoperative magnetic resonance in pediatric neurosurgical practice after 5 years of experience

Abstract

Background and objectives

High-field 1.5 T intraoperative magnetic resonance imaging (iMRI) was installed in our institution in 2020. Since then, it has been routinely used in pediatric neurosurgical practice. The purpose of this study was to describe our experience with this intraoperative imaging modality in a cohort of pediatric patients, focusing on the benefits, risks, and limitations in neurooncological practice and other entities such as the management of hydrocephalus and vascular disease.

Materials and methods

From February 2020 to April 2025, a series of consecutive pediatric cases involving various neurosurgical procedures were analyzed to describe the usefulness, safety, and challenges of using iMRI. Patients were categorized into five groups based on the type of surgery. Additional tumor resection after iMRI, early reoperation rate, and complications were analyzed.

Results

During this period, a total of 374 surgeries were performed with MRI. Of these, 141 were oncological surgeries; 7 were for vascular pathology; 10 were for hydrocephalus management; and 6 miscellaneous; 188 epilepsy surgeries and 22 functional pathology, which will be detailed in another submission. The mean age was 9.62 years (range: 2 months–18 years). After iMRI, the degree of surgical resection was improved in 11.4% (11/96) of cases of tumor resection surgeries. The early reoperation rate was 0% in the first month. This imaging control adapted postoperative management in 6 patients in whom complications were detected. In 52 of 164 of the patients analyzed (32%), iMRI was used as a final control, saving the patient from a second sedation that would have been necessary for early postoperative iMRI. The mean duration of the intraoperative imaging process was 54 ± 6 min, and 3–4 min for the check list.

Conclusions

iMRI in pediatric neurosurgical procedures was a useful, safe, and reliable tool. Its use improved the extension of tumor removal and avoids the need for early reintervention. Limitations were associated with the application of strict safety protocols to prevent accidents in highly complex environments and the inherent challenges associated with positioning pediatric patients due to headrests and non-compatible surgical tables.