SURG-29. A SINGLE CENTRE EXPERIENCE OF USING INTRA-OPERATIVE MRI IN MANAGING PEDIATRIC CRANIAL NEURO-ONCOLOGY CASES

The University of Malaya Medical Centre, Kuala Lumpur had acquired a intraoperative MRI (iMRI) brain suite via a public private initiative in September 2015. The MRI brain suite has a SIEMENS 1.5T system with NORAS coil system and NORAS head clamps in a two room solution. We would like to retrospectively review the cranial paediatric neuro-oncology cases that had surgery in this facility from September 2015 till December 2019. We would like to discuss our experience with regard to the clear benefits and the challenges in using such technology to aid in the surgery. The challenges include the physical setting up the paediatric case preoperatively, the preparation and performing the intraoperative scan, the interpretation of intraoperative images and making a decision and the utilisation of the new MRI data set to assist in the navigation to locate the residue safely. Also discuss the utility of the intraoperative images in the decision of subsequent adjuvant management. The use of iMRI also has other technical challenges such as ensuring the perimeter around the patient is free of ferromagnetic material, the process of transfer of the patient to the scanner and as a consequence increased duration of the surgery. CONCLUSION: Many elements in the use of iMRI has a learning curve and it improves with exposure and experience. In some areas only a high level of vigilance and SOP (Standard operating procedure) is required to minimize mishaps. Currently, the iMRI gives the best means of determining extent of resection before concluding the surgery.