Intraoperative MRI in Pediatric Neurosurgery

Social and technical trends in medicine are continuously driving the development of safer and less invasive neurosurgical procedures. Our success as anatomists, in conjunction with the high-quality and noninvasive diagnostic modalities of CT and MRI, has better defined surgical targets and avenues. Effective neuroimaging contributes to the arrival of patients with subtle – or even no – symptoms to our OR, increasing the stakes of neurosurgical intervention dramatically. Patient and/or parental expectations, education, and access to understandable medical information on the internet have increased dramatically, effectively raising the bar for what should be accomplished by attending physicians. In turn, the need for procedural refinement drives surgical innovation, several aspects of which were reviewed in the pediatric neurosurgical context in a recent article. In this chapter we will focus on the use of intraoperative magnetic resonance imaging (ioMRI) in the pediatric neurosurgical context, beginning with a history of its development with a review of current configurations and their results in the pediatric neurosurgical realm. We then share some key points about our experience using this real-time, high-resolution modality in the care of young patients.