Danil A Kozyrev1, Shlomi Constantini1, Deki Tsering2, Robert Keating2, Sharif Basal1, Jonathan Roth3. 1. Department of Pediatric Neurosurgery, Dana Children's Hospital, Tel Aviv Medical Center, Tel Aviv University, 6 Weizmann Street, 64239, Tel Aviv, Israel. 2. Children's National Medical Center, Washington, DC, USA. 3. Department of Pediatric Neurosurgery, Dana Children's Hospital, Tel Aviv Medical Center, Tel Aviv University, 6 Weizmann Street, 64239, Tel Aviv, Israel. jonaroth@gmail.com.
Abstract
PURPOSE: Pediatric brain incidentalomas are increasingly being diagnosed. As the posterior fossa (PF) is the location of most brain tumors in children, lesions of this region are of special interest. Currently, the natural history of incidental lesions in the PF is unknown. We present our experience treating such lesions. METHODS: A retrospective study was carried out in two large tertiary pediatric centers. Patients were included if they had an incidental PF lesion suspected of being a tumor, and diagnosed before the age of 20 years. We analyzed treatment strategy, pathology, and outcome of operated and non-operated cases. RESULTS: Seventy children (31 females) with a mean age of 8.4 ± 6.1 years were included. The three most common indications for imaging were headaches (16, assumed to be unrelated to the lesions), workup of unrelated conditions (14), and unspecified reasons (14). Twenty-seven patients (39%) were operated immediately, and 43 followed, of which 12 were eventually operated due to radiological changes, 28.9 ± 16.2 months after diagnosis. The most commonly found pathology was pilocytic astrocytomas (21 of 39 operated cases). Almost 10% were found to be malignant tumors including medulloblastomas (5) and ATRT (1). CONCLUSION: Incidental PF lesions in children include both benign and malignant tumors. While certain lesions may be followed, others may require surgical treatment. Specific treatment decisions are based on initial radiological appearance, change in radiological characteristics over time, location, and evolving symptoms. The surgical risks must be balanced vis-à-vis the risk of missing a high-grade tumor and the very rare risk of malignant transformation.
PURPOSE: Pediatric brain incidentalomas are increasingly being diagnosed. As the posterior fossa (PF) is the location of most brain tumors in children, lesions of this region are of special interest. Currently, the natural history of incidental lesions in the PF is unknown. We present our experience treating such lesions. METHODS: A retrospective study was carried out in two large tertiary pediatric centers. Patients were included if they had an incidental PF lesion suspected of being a tumor, and diagnosed before the age of 20 years. We analyzed treatment strategy, pathology, and outcome of operated and non-operated cases. RESULTS: Seventy children (31 females) with a mean age of 8.4 ± 6.1 years were included. The three most common indications for imaging were headaches (16, assumed to be unrelated to the lesions), workup of unrelated conditions (14), and unspecified reasons (14). Twenty-seven patients (39%) were operated immediately, and 43 followed, of which 12 were eventually operated due to radiological changes, 28.9 ± 16.2 months after diagnosis. The most commonly found pathology was pilocytic astrocytomas (21 of 39 operated cases). Almost 10% were found to be malignant tumors including medulloblastomas (5) and ATRT (1). CONCLUSION: Incidental PF lesions in children include both benign and malignant tumors. While certain lesions may be followed, others may require surgical treatment. Specific treatment decisions are based on initial radiological appearance, change in radiological characteristics over time, location, and evolving symptoms. The surgical risks must be balanced vis-à-vis the risk of missing a high-grade tumor and the very rare risk of malignant transformation.
Authors: Matthew Mistry; Nataliya Zhukova; Daniele Merico; Patricia Rakopoulos; Rahul Krishnatry; Mary Shago; James Stavropoulos; Noa Alon; Jason D Pole; Peter N Ray; Vilma Navickiene; Joshua Mangerel; Marc Remke; Pawel Buczkowicz; Vijay Ramaswamy; Ana Guerreiro Stucklin; Martin Li; Edwin J Young; Cindy Zhang; Pedro Castelo-Branco; Doua Bakry; Suzanne Laughlin; Adam Shlien; Jennifer Chan; Keith L Ligon; James T Rutka; Peter B Dirks; Michael D Taylor; Mark Greenberg; David Malkin; Annie Huang; Eric Bouffet; Cynthia E Hawkins; Uri Tabori Journal: J Clin Oncol Date: 2015-02-09 Impact factor: 44.544
Authors: Jonathan Roth; Robert F Keating; John S Myseros; Amanda L Yaun; Suresh N Magge; Shlomi Constantini Journal: J Neurosurg Pediatr Date: 2012-07-20 Impact factor: 2.375
Authors: Juan M García-Gómez; Jan Luts; Margarida Julià-Sapé; Patrick Krooshof; Salvador Tortajada; Javier Vicente Robledo; Willem Melssen; Elies Fuster-García; Iván Olier; Geert Postma; Daniel Monleón; Angel Moreno-Torres; Jesús Pujol; Ana-Paula Candiota; M Carmen Martínez-Bisbal; Johan Suykens; Lutgarde Buydens; Bernardo Celda; Sabine Van Huffel; Carles Arús; Montserrat Robles Journal: MAGMA Date: 2008-11-07 Impact factor: 2.310
Authors: Jinghui Zhang; Gang Wu; Claudia P Miller; Ruth G Tatevossian; James D Dalton; Bo Tang; Wilda Orisme; Chandanamali Punchihewa; Matthew Parker; Ibrahim Qaddoumi; Fredrick A Boop; Charles Lu; Cyriac Kandoth; Li Ding; Ryan Lee; Robert Huether; Xiang Chen; Erin Hedlund; Panduka Nagahawatte; Michael Rusch; Kristy Boggs; Jinjun Cheng; Jared Becksfort; Jing Ma; Guangchun Song; Yongjin Li; Lei Wei; Jianmin Wang; Sheila Shurtleff; John Easton; David Zhao; Robert S Fulton; Lucinda L Fulton; David J Dooling; Bhavin Vadodaria; Heather L Mulder; Chunlao Tang; Kerri Ochoa; Charles G Mullighan; Amar Gajjar; Richard Kriwacki; Denise Sheer; Richard J Gilbertson; Elaine R Mardis; Richard K Wilson; James R Downing; Suzanne J Baker; David W Ellison Journal: Nat Genet Date: 2013-04-14 Impact factor: 38.330