Giant Pediatric Supratentorial Tumor: Clinical Feature and Surgical Strategy

Abstract

PurposeTo analyze the clinical character of giant pediatric supratentorial tumor (GPST) and explore prognostic factors.Materials and MethodsWe analyzed the clinical data comprising of 35 cases of GPST from a single center between January 2015 and December 2020. The tumor volume was measured by 3D slicer software based on preoperative magnetic resonance imaging (MRI). Glasgow Outcome Scale (GOS) was used to evaluate the short-term prognosis.ResultThe tumor volume varied from 27.3 to 632.8 ml (mean volume 129.8 ml/ median volume 82.8 ml). Postoperative histopathological types include ependymoma, pilocytic astrocytoma, choroid plexus papilloma (CPP), craniopharyngioma, primitive neuroectoderm tumor (PNET), choroid plexus carcinoma (CPC), immature teratoma, atypical teratoid rhabdoid tumor (AT/RT), anaplastic astrocytoma, and gangliocytoma. Tumors in children younger than 3 years and tumors located at the hemispheres appeared to be larger than their respective counterparts, though no statistical significance was found. A patient with giant immature teratoma died during the operation because of excessive bleeding. Postoperative complications include cerebrospinal fluid subgaleal collection/effusion, infection, neurological deficits, and seizures. The mean GOS score of patients with GPST in 6 months is 3.43 ± 1.12, and 83% of patients (29/35) showed improvement. Favorable GPST characteristics to indicated better GOS included small tumor (≤100 ml) (p = 0.029), low-grade (WHO I-II) (p = 0.001), and gross total resection (GTR) (p = 0.015). WHO grade was highly correlated with GOS score (correlation coefficient = −0.625, p < 0.001). GTR and tumor volume were also correlated (correlation coefficient = −0.428, p = 0.010).ConclusionThe prognosis of GPST is highly correlated with the histopathological type. Smaller tumors are more likely to achieve GTR and might lead to a higher GOS score. Early diagnosis and GTR of the tumor are important for GPST management.

Feasibility of Augmented Reality for Pediatric Giant Supratentorial Tumors: A Report of Three Cases

“…At the time of diagnosis, surgery is time-sensitive owing to high risks of neurological deterioration. Most published literature is limited to small retrospective case series [5,6,18,19]. To date, there are no established guidelines with regard to the optimal management of GSBT [20].…”

“…Brain tumors are the most common solid tumors in children, comprising 25% of all childhood cancers [1,2]. Conversely, giant supratentorial brain tumors (GSBTs) referring to tumors larger than 5 cm that arise in the supratentorial compartment make up only a small proportion of this group [3][4][5]. Cumulative studies have highlighted the unique challenges of managing these patients due to their large sizes, heterogeneous histology, and age-related physiology [5][6][7].…”

“…Conversely, giant supratentorial brain tumors (GSBTs) referring to tumors larger than 5 cm that arise in the supratentorial compartment make up only a small proportion of this group [3][4][5]. Cumulative studies have highlighted the unique challenges of managing these patients due to their large sizes, heterogeneous histology, and age-related physiology [5][6][7]. For GSBT surgery, it is well-established that young children are at high risk of operative complications such as profuse bleeding, in addition to other significant postoperative morbidities [3].…”

Pathophysiology-Based Management of Secondary Injuries and Insults in TBI

“…Calcium activates pathways that release free radicals from mitochondria and increase nitric oxide (NO) production through inducible NO synthase (iNOS) [ 39 ]. Nicotinamide adenine dinucleotide (NADPH) oxidase produces reactive oxygen species (ROS) within the first hour after trauma [ 40 ]. ROS increases affinity to NO, forming peroxynitrites (ONOO-) [ 40 ], which destroy the cytoskeleton, cell membranes, and DNA [ 41 ].…”

“…Nicotinamide adenine dinucleotide (NADPH) oxidase produces reactive oxygen species (ROS) within the first hour after trauma [ 40 ]. ROS increases affinity to NO, forming peroxynitrites (ONOO-) [ 40 ], which destroy the cytoskeleton, cell membranes, and DNA [ 41 ]. NO inhibits cytochrome c oxidase, causing mitochondrial disruption and cell death [ 42 ].…”