BACKGROUND AND OBJECTIVES:High-field 1.5T 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±6min, and 3-4min 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.
Malignant triton tumour constitutes a rare and particularly aggressive subgroup within the so-called malignant peripheral nerve sheath tumours. It belongs to the group of sarcomas and is diagnosed more frequently and aggressively in patients with neurofibromatosis type I, with a peak age of around 30 years. They develop preferentially in medium and large nerves such as cranial nerves, plexuses and nerve roots. The 5-year survival rate is approximately 5-15% according to published series, compared to 34-52% in other malignant tumours of the nerve sheaths. Radical surgery with clear margins followed by radiotherapy for local control appears to offer the best results in terms of survival. We describe two cases treated at our centre and review the scientific literature, highlighting the role of the pathologist and neurosurgeon in their management.
The vidian nerve is a well-recognized landmark in endoscopic endonasal skull base surgery, as it helps identify the internal carotid artery at the foramen lacerum and allows surgeons to safely approach the petrous region. However, to the best of the authors' knowledge, there are no clearly defined landmarks when the surgical corridor advances posteriorly and superiorly through the petrous bone, behind the internal carotid artery. This study aimed to provide anatomical and radiological references, based on patient-specific anatomy, for approaching the petrous apex through endoscopic endonasal approaches. Twenty petrous bones from ten patients were analyzed, defining skull base landmarks and their posterior projections, namely the newly named naso-vidian, naso-carotid, and naso-paraclival lines. The distance between these projections and other standard skull base landmarks was measured to establish their anatomical correlations. The posterior projections of the naso-vidian and naso-carotid lines deviated by a mean of 2.5mm and 2.1mm, respectively, when measured against the internal acoustic meatus. In postoperative CT scans of endonasal petrosectomies performed at our center, the average distance from the bone edge reached to the antero-inferior border of the internal acoustic meatus was 1.7mm. The naso-vidian and naso-carotid lines may function as suitable references when approaching the petrous apex, as they commonly project towards the internal acoustic meatus, aiding in preoperative planning for endonasal skull base approaches to this region.
