Martin U Schuhmann1,2, Steven W Warmann3, Cristian Urla4, Jörg Fuchs4, Alexander Grimm5, Andreas Schmidt4, Jürgen Schäfer6. 1. Division of Pediatric Neurosurgery, Department of Neurosurgery, University Hospital of Tuebingen, Tuebingen, Germany. 2. Center of Neurofibromatosis, Center of Rare Diseases, University Hospital of Tuebingen, Tuebingen, Germany. 3. Department of Pediatric Surgery and Pediatric Urology, University Children's Hospital of Tuebingen, Hoppe-Seyler-Strasse 3, 72076, Tuebingen, Germany. steven.warmann@med.uni-tuebingen.de. 4. Department of Pediatric Surgery and Pediatric Urology, University Children's Hospital of Tuebingen, Hoppe-Seyler-Strasse 3, 72076, Tuebingen, Germany. 5. Neuromuscular Division, Department of Neurology, University Hospital of Tuebingen, Tuebingen, Germany. 6. Department of Diagnostic and Interventional Radiology, University Hospital of Tuebingen, Tuebingen, Germany.
Abstract
PURPOSE: Success of pediatric solid tumor surgery is regularly hampered by infiltration of essential neurovascular structures. A surgical dilemma arises when imaging data suggest a conflict between complete resection and preservation of neurological function. The aim of the study was to analyze data of children harboring tumors with involvement of neurovascular structure treated by an interdisciplinary pediatric surgical/neurosurgical team. METHODS: We retrospectively analyzed data of 25 children undergoing surgery for solid tumors, in whom preoperative imaging showed a relevant involvement of nerve structures. Surgery was simultaneously performed by a pediatric onco-surgeon and a pediatric neurosurgeon with peripheral nerve expertise, including intraoperative electrophysiological monitoring. RESULTS: The following tumors were treated: NF1 associated neurofibromas (10), neuroblastomas (5), desmoid tumors (2), MPNST (2), ganglioneuroma (1), Ewing sarcoma (1), infantile fibromatosis (1), PNET (1), rhabdomyosarcoma (1), angiolipoma (1). The most frequent tumor localizations were the pelvis (n = 7) and retroperitoneal region (n = 6). Median age at surgery was 8 years (1.5-16). Macroscopically complete tumor resection was achieved in 24/25 patients. In 2/4 patients with limb tumors an amputation was planned externally. In both, a limb-salvage procedure was possible. Transient postoperative neurological deficits occurred in 2/25 patients. Four patients had tumor relapses. All but one are alive after a median follow-up of 46 months (2-155). CONCLUSIONS: Simultaneous interdisciplinary pediatric surgical/neurosurgical approach enables radical tumor resection with preservation of neurological function in patients suffering from solid tumors with involvement of relevant neurovascular structures. This approach should be performed by experienced surgeons in reference pediatric onco-surgical centers.
PURPOSE: Success of pediatric solid tumor surgery is regularly hampered by infiltration of essential neurovascular structures. A surgical dilemma arises when imaging data suggest a conflict between complete resection and preservation of neurological function. The aim of the study was to analyze data of children harboring tumors with involvement of neurovascular structure treated by an interdisciplinary pediatric surgical/neurosurgical team. METHODS: We retrospectively analyzed data of 25 children undergoing surgery for solid tumors, in whom preoperative imaging showed a relevant involvement of nerve structures. Surgery was simultaneously performed by a pediatric onco-surgeon and a pediatric neurosurgeon with peripheral nerve expertise, including intraoperative electrophysiological monitoring. RESULTS: The following tumors were treated: NF1 associated neurofibromas (10), neuroblastomas (5), desmoid tumors (2), MPNST (2), ganglioneuroma (1), Ewing sarcoma (1), infantile fibromatosis (1), PNET (1), rhabdomyosarcoma (1), angiolipoma (1). The most frequent tumor localizations were the pelvis (n = 7) and retroperitoneal region (n = 6). Median age at surgery was 8 years (1.5-16). Macroscopically complete tumor resection was achieved in 24/25 patients. In 2/4 patients with limb tumors an amputation was planned externally. In both, a limb-salvage procedure was possible. Transient postoperative neurological deficits occurred in 2/25 patients. Four patients had tumor relapses. All but one are alive after a median follow-up of 46 months (2-155). CONCLUSIONS: Simultaneous interdisciplinary pediatric surgical/neurosurgical approach enables radical tumor resection with preservation of neurological function in patients suffering from solid tumors with involvement of relevant neurovascular structures. This approach should be performed by experienced surgeons in reference pediatric onco-surgical centers.
Authors: L Antoniello; G Cecchetto; M Carli; P Dall'Igna; G Bisogno; R Lo Piccolo; C Gigante; I Zanetti; M Guglielmi Journal: Pediatr Med Chir Date: 2003 Jul-Aug