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EoR was graded as gross total (GTR; no residual tumor), sub-total (STR;\u2009&gt;\u200990% tumor resection), and partial resection (PR;\u2009&lt;\u200990% tumor resection).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 118 ioMRI-guided interventions were performed in 108 individual children aged\u2009\u2264\u200918\u00a0years. The intended EoR determined pre-operatively was GTR in 81 cases (68.6%), STR in 24 (20.3%), and PR in 13 (11.0%). IoMRI confirmed the intended EoR achieved in 78\/118 procedures (66.1%), demonstrating GTR in 48 cases (40.7%), STR in 50 (42.4%), and PR in 20 (16.9%). In 48 cases (40.7%), ioMRI findings prompted further intraoperative evaluation; additional tumor resection was performed in 45 cases (93.8%), resulting in improved EoR.\u00a0The final EoR distribution after ioMRI-guidance was 80 GTR (67.8%), 25 STR (21.2%), and 13 PR (11.0%), resulting in a rate of achieving the intended EoR in 99.2% of cases (117\/118). Surgical site infections (SSI) occurred in 4 cases (3.4%).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This study highlights the substantial impact of ioMRI in pediatric brain tumor surgery, demonstrating a high rate of surgical site reopening for residual tumor resection, which substantially improved the EoR and minimized the need for a second operation \u2013 without increasing SSI incidence.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00381-026-07456-w","type":"journal-article","created":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T22:15:26Z","timestamp":1789596926000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Intraoperative MRI in pediatric brain tumor surgery: Optimizing surgical decision-making and extent of resection"],"prefix":"10.1007","volume":"42","author":[{"given":"Jennifer","family":"To","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timothy","family":"M\u00fcller","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oliver","family":"Bozinov","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luca","family":"Regli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Niklaus","family":"Krayenb\u00fchl","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julia","family":"Velz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,9,17]]},"reference":[{"key":"7456_CR1","doi-asserted-by":"publisher","first-page":"1367","DOI":"10.1007\/s00234-021-02671-5\/Published","volume":"63","author":"S Avula","year":"2021","unstructured":"Avula S, Jaspan T, Pizer B, Pettorini B, Garlick D, Hennigan D, Mallucci C (2021) Comparison of intraoperative and post-operative 3-T MRI performed at 24\u201372 h following brain tumour resection in children. 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