University of Surrey

Test tubes in the lab Research in the ATI Dance Research

The role of early intra-operative MRI in partial resection of optic pathway/hypothalamic gliomas in children.

Millward, Christopher, Perez Da Rosa, Sandra, Avula, Shivaram, Ellenbogen, Jonathan R, Spiteri, Michaela, Lewis, Emma, Didi, Mo and Malucci, Conor (2015) The role of early intra-operative MRI in partial resection of optic pathway/hypothalamic gliomas in children. Child's Nervous System, 31 (11). pp. 2055-2062.


Download (2MB) | Preview


Optic pathway/hypothalamic gliomas (OPHGs) are generally benign but situated in an exquisitely sensitive brain region. They follow an unpredictable course and are usually impossible to resect completely. We present a case series of 10 patients who underwent surgery for OPHGs with the aid of intra-operative MRI (ioMRI). The impact of ioMRI on OPHG resection is presented, and a role for ioMRI in partial resection is discussed. Ten patients with OPHGs managed surgically utilising ioMRI at Alder Hey Children's Hospital between 2010 and 2013 were retrospectively identified. Demographic and relevant clinical data were obtained. MRI was used to estimate tumour volume pre-operatively and post-resection. If ioMRI demonstrated that further resection was possible, second-look surgery, at the discretion of the operating surgeon, was performed, followed by post-operative imaging to establish the final status of resection. Tumour volume was estimated for each MR image using the MRIcron software package. Control of tumour progression was achieved in all patients. Seven patients had, on table, second-look surgery with significant further tumour resection following ioMRI without any surgically related mortality or morbidity. The median additional quantity of tumour removed following second-look surgery, as a percentage of the initial total volume, was 27.79 % (range 11.2-59.2 %). The final tumour volume remaining with second-look surgery was 23.96 vs. 33.21 % without (p = 0.1). OPHGs are technically difficult to resect due to their eloquent location, making them suitable for debulking resection only. IoMRI allows surgical goals to be reassessed intra-operatively following primary resection. Second-look surgery can be performed if possible and necessary and allows significant quantities of extra tumour to be resected safely. Although the clinical significance of additional tumour resection is not yet clear, we suggest that ioMRI is a safe and useful additional tool, to be combined with advanced neuro navigation techniques for partial tumour resection.

Item Type: Article
Divisions : Faculty of Engineering and Physical Sciences > Electronic Engineering > Centre for Vision Speech and Signal Processing
Authors :
Millward, Christopher
Perez Da Rosa, Sandra
Avula, Shivaram
Ellenbogen, Jonathan R
Didi, Mo
Malucci, Conor
Date : November 2015
DOI : 10.1007/s00381-015-2830-3
Additional Information : The final publication is available at Springer via
Depositing User : Michaela Spiteri
Date Deposited : 01 Dec 2015 18:47
Last Modified : 16 Jan 2019 17:00

Actions (login required)

View Item View Item


Downloads per month over past year

Information about this web site

© The University of Surrey, Guildford, Surrey, GU2 7XH, United Kingdom.
+44 (0)1483 300800