End-of-surgery MRI following pediatric neuro-oncological tumor resection.

PURPOSE: Magnetic resonance imaging (MRI) is routinely used to assess extent of resection after pediatric brain and spine tumor surgery and is commonly performed intraoperatively (ioMRI) or postoperatively (postopMRI). This study describes the implementation, feasibility, and workflow characteristics of end-of-surgery MRI (eosMRI), performed after wound closure but before termination of general anesthesia within a single-center pediatric neurosurgical practice and reports procedural and patient-related parameters observed over a 10-year period.

METHODS

We conducted a retrospective, single-center observational study including all pediatric brain and spine tumor surgeries performed with eosMRI, ioMRI, or postopMRI between July 2013 and September 2022. MRI modality selection followed institutional workflow patterns and surgeon judgment rather than predefined allocation criteria. Recorded variables included anesthesia time, surgery duration, imaging duration, patient age, tumor location, imaging-guided additional resection, and extent of resection (EOR).

RESULTS

A total of 129 surgeries in 106 children (mean age 9 years, range 0.3-18) were analyzed: 45 eosMRI (35%), 16 ioMRI (12%), and 68 postopMRI (53%). Within this workflow, eosMRI and ioMRI were associated with longer anesthesia times compared to postopMRI, whereas total surgery time was prolonged only in the ioMRI group. Imaging duration did not differ significantly across modalities. Patients managed with eosMRI were younger and more frequently had infratentorial tumors, reflecting institutional selection patterns. Extent of resection (EOR) distribution did not differ statistically between modalities.

CONCLUSION

This retrospective single-center experience demonstrates the feasibility of eosMRI within a pediatric neurosurgical workflow, particularly regarding operative logistics and anesthesia exposure. These descriptive findings may inform perioperative imaging considerations in comparable institutional settings for pediatric neuro-oncological surgery.