{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T16:06:16Z","timestamp":1776096376860,"version":"3.50.1"},"reference-count":52,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,1,2]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>The use of intraoperative MRI (iMRI) has been well described for endoscopic endonasal transsphenoidal surgery (EETS) in adults. However, literature on its use for EETS in pediatric patients is lacking. The objective of this study was to evaluate the usefulness, efficacy, and safety of iMRI for EETS in the pediatric population.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>A retrospective review of patient medical records and imaging was performed for all patients younger than 18 years of age who underwent EETS at a single institution from January 2005 to December 2024. Based on whether iMRI was used, cases were divided into two groups and compared. Collected data included the preoperative goal of the surgery (biopsy, debulking\/decompression, subtotal resection [STR], and gross-total resection [GTR]) and the iMRI timing (predissection, intradissection, and postdissection), purpose, and findings, as well as how these findings impacted intraoperative surgical management and whether the preoperative goal of the surgery was met. Additional demographic and clinical variables were assessed, including age at surgery, surgery duration, hospital length of stay (LOS), whether postoperative MRI was performed during the same admission, repeat surgery, histopathological diagnosis, complications, long-term tumor progression\/recurrence, and use of adjuvant therapy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>Twenty-two EETS procedures were performed among 21 patients with sellar\/suprasellar pathologies; iMRI was used in 13 of 22 cases (12 patients, age range 6\u201317 years) including 4 predissection, 8 pre- and intradissection, and 1 postdissection iMRI evaluations. Pathologies included mostly craniopharyngiomas (46.2%) and pituitary adenomas (38.5%). Surgical goals included biopsy (n = 2), debulking\/decompression (n = 3), STR (n = 1), and GTR (n = 7) and were achieved in 12 of 13 cases (92.3%). The mean operative duration was 6.1 hours, mean LOS was 2.9 days, and mean follow-up was 4.3 years. The rate of complications was 38.5% (4 pituitary insufficiency\/diabetes insipidus [DI] and 1 CSF leak). Two adenomas recurred and required repeat surgery. For the 9 patients (age range 5\u201317 years) in the non-iMRI EETS group, the most common pathologies were Rathke cleft cyst (33.3%), craniopharyngioma (22.2%), and adenoma (22.2%). The surgical goal was achieved in 66.6%, with no statistically significant difference compared with the iMRI group (p = 0.264). The operative time (mean 5.8 hours), LOS (mean 4.3 days), and complication rate (22.2%) were similar between the non-iMRI and iMRI groups. Three patients in the non-iMRI group (2 with craniopharyngiomas and 1 with a Rathke cyst) required reoperation for recurrence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>For pediatric EETS, iMRI showed promise as an effective and safe surgical adjunct to help verify, in the same setting, that the goals of surgery had been met. However, the outcome measures studied herein were not better than those achieved without the use of iMRI.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2025.8.peds2529","type":"journal-article","created":{"date-parts":[[2026,1,8]],"date-time":"2026-01-08T17:46:22Z","timestamp":1767894382000},"page":"237-246","source":"Crossref","is-referenced-by-count":0,"title":["Intraoperative MRI for endoscopic endonasal transsphenoidal surgery in children"],"prefix":"10.3171","volume":"37","author":[{"given":"Neevya","family":"Balasubramaniam","sequence":"first","affiliation":[{"name":"Department of Pediatric Surgery, Division of Neurosurgery, Montreal Children\u2019s Hospital, Montreal, Quebec;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jean-Pierre","family":"Farmer","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, Division of Neurosurgery, Montreal Children\u2019s Hospital, Montreal, Quebec;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marc A.","family":"Tewfik","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology - Head and Neck Surgery, McGill University Health Centre, Montreal, Quebec;"},{"name":"Department of Pediatric Surgery, Division of Otolaryngology, Montreal Children\u2019s Hospital, Montreal, Quebec;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joseph S.","family":"Schwartz","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology - Head and Neck Surgery, Jewish General Hospital, McGill University Health Centre, Montreal, Quebec; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sam J.","family":"Daniel","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology - Head and Neck Surgery, McGill University Health Centre, Montreal, Quebec;"},{"name":"Department of Pediatric Surgery, Division of Otolaryngology, Montreal Children\u2019s Hospital, Montreal, Quebec;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tobial","family":"McHugh","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology - Head and Neck Surgery, McGill University Health Centre, Montreal, Quebec;"},{"name":"Department of Pediatric Surgery, Division of Otolaryngology, Montreal Children\u2019s Hospital, Montreal, Quebec;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christine","family":"Saint-Martin","sequence":"additional","affiliation":[{"name":"Department of Medical Imaging, Montreal Children\u2019s Hospital, McGill University Health Centre, Montreal, Quebec, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roy W. R.","family":"Dudley","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, Division of Neurosurgery, Montreal Children\u2019s Hospital, Montreal, Quebec;"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"4","key":"b1","series-title":"Biomedicines","first-page":"356","article-title":"Typical pediatric brain tumors occurring in adults\u2014differences in management and outcome","volume":"9","author":"Greuter L","year":"2021","unstructured":"Greuter L, Guzman R, Soleman J. Typical pediatric brain tumors occurring in adults\u2014differences in management and outcome. Biomedicines. 2021;9(4):356."},{"issue":"2","key":"b2","series-title":"J Neurosurg","first-page":"293","article-title":"Surgical complications associated with the endoscopic endonasal transsphenoidal approach for pituitary adenomas","volume":"97","author":"Cappabianca P","year":"2002","unstructured":"Cappabianca P, Cavallo LM, Colao A, de Divitiis E. Surgical complications associated with the endoscopic endonasal transsphenoidal approach for pituitary adenomas. J Neurosurg. 2002;97(2):293\u2013298."},{"issue":"10-11","key":"b3","series-title":"Childs Nerv Syst","first-page":"692","article-title":"The role of the endoscopic transsphenoidal approach in pediatric neurosurgery","volume":"16","author":"de Divitiis E","year":"2000","unstructured":"de Divitiis E, Cappabianca P, Gangemi M, Cavallo LM. The role of the endoscopic transsphenoidal approach in pediatric neurosurgery. Childs Nerv Syst. 2000;16(10-11):692\u2013696."},{"issue":"11","key":"b4","series-title":"Int J Pediatr Otorhinolaryngol","first-page":"1298","article-title":"Endoscopic endonasal transsphenoidal surgery for sellar tumors in children","volume":"74","author":"Locatelli D","year":"2010","unstructured":"Locatelli D, Massimi L, Rigante M,  Endoscopic endonasal transsphenoidal surgery for sellar tumors in children. 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Neuro Oncol. 2023;25(12):2117\u20132133."},{"issue":"6","key":"b13","series-title":"Neurosurg Focus","first-page":"E14","article-title":"Ten years\u2019 experience with intraoperative MRI-assisted transsphenoidal pituitary surgery","volume":"48","author":"Hlav\u00e1\u010d M","year":"2020","unstructured":"Hlav\u00e1\u010d M, Knoll A, Mayer B,  Ten years\u2019 experience with intraoperative MRI-assisted transsphenoidal pituitary surgery. Neurosurg Focus. 2020;48(6):E14."},{"key":"b14","series-title":"World Neurosurg","first-page":"144","article-title":"The value of intraoperative magnetic resonance imaging in endoscopic and microsurgical transsphenoidal pituitary adenoma resection","volume":"102","author":"Pal\u2019a A","year":"2017","unstructured":"Pal\u2019a A, Knoll A, Brand C,  The value of intraoperative magnetic resonance imaging in endoscopic and microsurgical transsphenoidal pituitary adenoma resection. 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J Neurosurg Pediatr. 2017;19(1):77\u201384."},{"issue":"3","key":"b20","series-title":"J Neurosurg Pediatr","first-page":"259","article-title":"Intraoperative magnetic resonance imaging to reduce the rate of early reoperation for lesion resection in pediatric neurosurgery","volume":"9","author":"Shah MN","year":"2012","unstructured":"Shah MN, Leonard JR, Inder G,  Intraoperative magnetic resonance imaging to reduce the rate of early reoperation for lesion resection in pediatric neurosurgery. J Neurosurg Pediatr. 2012;9(3):259\u2013264."},{"issue":"5","key":"b21","series-title":"J Neurosurg Pediatr","first-page":"467","article-title":"Application of intraoperative high-field magnetic resonance imaging in pediatric neurosurgery","volume":"4","author":"Levy R","year":"2009","unstructured":"Levy R, Cox RG, Hader WJ, Myles T, Sutherland GR, Hamilton MG. Application of intraoperative high-field magnetic resonance imaging in pediatric neurosurgery. 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Biomedicines. 2021;9(4):356."},{"issue":"2","key":"b2","series-title":"J Neurosurg","first-page":"293","article-title":"Surgical complications associated with the endoscopic endonasal transsphenoidal approach for pituitary adenomas","volume":"97","author":"Cappabianca P","year":"2002","unstructured":"Cappabianca P, Cavallo LM, Colao A, de Divitiis E. Surgical complications associated with the endoscopic endonasal transsphenoidal approach for pituitary adenomas. J Neurosurg. 2002;97(2):293\u2013298."},{"issue":"10-11","key":"b3","series-title":"Childs Nerv Syst","first-page":"692","article-title":"The role of the endoscopic transsphenoidal approach in pediatric neurosurgery","volume":"16","author":"de Divitiis E","year":"2000","unstructured":"de Divitiis E, Cappabianca P, Gangemi M, Cavallo LM. The role of the endoscopic transsphenoidal approach in pediatric neurosurgery. 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J Craniofac Surg. 2015;26(6):1818\u20131822."},{"key":"b6","series-title":"Int J Pediatr Otorhinolaryngol","first-page":"109786","article-title":"Endoscopic endonasal transsphenoidal approach for pediatric craniopharyngiomas: a case series","volume":"130","author":"Schelini JC","year":"2020","unstructured":"Schelini JC, Cavalheiro S, Dastoli PA,  Endoscopic endonasal transsphenoidal approach for pediatric craniopharyngiomas: a case series. Int J Pediatr Otorhinolaryngol. 2020;130:109786."},{"issue":"8","key":"b7","series-title":"Arch Dis Child","first-page":"774","article-title":"Surgical outcomes of the endoscopic transsphenoidal route to pituitary tumours in paediatric patients >10 years of age: 5 years of experience at a single institute","volume":"100","author":"Zhan R","year":"2015","unstructured":"Zhan R, Xu G, Wiebe TM, Li X. Surgical outcomes of the endoscopic transsphenoidal route to pituitary tumours in paediatric patients >10 years of age: 5 years of experience at a single institute. Arch Dis Child. 2015;100(8):774\u2013778."},{"issue":"3","key":"b8","series-title":"J Neurosurg Pediatr","first-page":"246","article-title":"Transnasal endoscopic approach for pediatric skull base lesions: a case series","volume":"24","author":"Quon JL","year":"2019","unstructured":"Quon JL, Kim LH, Hwang PH,  Transnasal endoscopic approach for pediatric skull base lesions: a case series. J Neurosurg Pediatr. 2019;24(3):246\u2013257."},{"issue":"3","key":"b9","series-title":"AJNR Am J Neuroradiol","first-page":"348","article-title":"Achieving gross total resection of brain tumors: intraoperative MR imaging can make a big difference","volume":"23","author":"Bradley WG","year":"2002","unstructured":"Bradley WG. Achieving gross total resection of brain tumors: intraoperative MR imaging can make a big difference. 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Neurosurg Focus. 2020;48(6):E14."},{"key":"b14","series-title":"World Neurosurg","first-page":"144","article-title":"The value of intraoperative magnetic resonance imaging in endoscopic and microsurgical transsphenoidal pituitary adenoma resection","volume":"102","author":"Pal\u2019a A","year":"2017","unstructured":"Pal\u2019a A, Knoll A, Brand C,  The value of intraoperative magnetic resonance imaging in endoscopic and microsurgical transsphenoidal pituitary adenoma resection. World Neurosurg. 2017;102:144\u2013150."},{"issue":"2","key":"b15","series-title":"J Neurosurg","first-page":"346","article-title":"Determining the utility of intraoperative magnetic resonance imaging for transsphenoidal surgery: a retrospective study","volume":"120","author":"Coburger J","year":"2014","unstructured":"Coburger J, K\u00f6nig R, Seitz K, B\u00e4zner U, Wirtz CR, Hlavac M. Determining the utility of intraoperative magnetic resonance imaging for transsphenoidal surgery: a retrospective study. 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