PhD Defense: Exploring pathways MRI insights into a child’s brain in the operating theatre

Most children who undergo brain tumor surgery have a tumor in the posterior fossa, the lower back part of the brain. Following this type of surgery, some children develop speech problems and may temporarily lose the ability to speak altogether. We still don't fully understand why this happens in some children but not in others.
In this study, we used a specialized MRI scanner located right next to the operating room, allowing us to image the brain while surgery is taking place. We focused on a specific brain pathway that may play a key role in these speech problems: the dentato-rubro-thalamic tract, essentially a "railway line" connecting the cerebellum to a major relay hub deep in the brain, and from there onward to the areas that control movement and speech.
We first looked at how to reliably acquire MRI images in this challenging surgical setting. This turned out to be achievable, as long as the technical parameters were carefully tuned.
Next, we examined whether this pathway undergoes structural changes during surgery. It does, and critically, those changes were more pronounced in children who went on to develop speech problems than in those who did not.
This work lays the groundwork for future studies aimed at giving neurosurgeons near real-time insight into which brain pathways are at risk during surgery, ultimately helping to improve outcomes for children with brain tumors.