• Karl Roessler, Fabian Winter, Barbara Kiesel, Julia Shawarba, Jonathan Wais, Matthias Tomschik, Gregor Kasprian, Martin Niederle, Gilbert Hangel, Thomas Czech, and Christian Dorfer.
• Department of Neurosurgery, Medical University of Vienna, Vienna, Austria. Electronic address: Karl.roessler@meduniwien.ac.at.
• World Neurosurg. 2024 Feb 1; 182: e253e261e253-e261.

ObjectiveTo evaluate the neurosurgical and economic effectiveness of a newly launched intraoperative high-field (3T) magnetic resonance imaging (MRI) suite for pediatric tumor and epilepsy neurosurgery.MethodsAltogether, 148 procedures for 124 pediatric patients (mean age, 8.7 years; range, 0-18 years) within a 2.5-year period were undertaken in a 2-room intraoperative MRI (iopMRI) suite. Surgery was performed mainly for intractable epilepsy (n = 81; 55%) or pediatric brain tumors (n = 65; 44%) in the supine (n = 113; 76%) and prone (n = 35; 24%) positions. The mean time of iopMRI from draping to re-surgery was 50 minutes.ResultsIopMRI was applied not in all but in 64 of 148 procedures (43%); in 45 procedures (31%), iopMRI was estimated unnecessary at the end of surgery based on the leading surgeon's decision. In the remaining 39 procedures (26%), ultra-early postoperative MRI was carried out after closure with the patient still sterile in the head coil. Of the 64 procedures with iopMRI, second-look surgery was performed in 26% (in epilepsy surgery in 17%, in tumor surgery in 9%). We did not encounter any infections, wound revisions, or position-related or anesthesiology-related complications.ConclusionsWe used iopMRI in less than half of pediatric tumor and epilepsy surgery for which it was scheduled initially. Therefore, high costs argue against its routine use in pediatric neurosurgery, although it optimized surgical results in one quarter of patients and met high safety standards.Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.

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