Intramedullary tumors in children

Chatterjee, Sandip; Chatterjee, Uttara

doi:10.4103/1817-1745.85718

Cited by 10 publications

(4 citation statements)

References 43 publications

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“…6,7,21,27,35 At clinical presentation, the most commonly reported symptoms are pain, motor deficits, frequent falls, sensory symptoms, and sphincter dysfunction. 1,8,27,28 Surgical management of spinal cord astrocytomas can vary from biopsy to attempted gross-total resection (GTR). The extent of resection is influenced by age, tumor size and location, degree of dissemination, patient preference, and quality of life.…”

mentioning

confidence: 99%

Surgical outcomes of pediatric spinal cord astrocytomas: systematic review and meta-analysis

Azad¹,

Pendharkar²,

Pan³

et al. 2018

Journal of Neurosurgery: Pediatrics

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OBJECTIVEPediatric spinal astrocytomas are rare spinal lesions that pose unique management challenges. Therapeutic options include gross-total resection (GTR), subtotal resection (STR), and adjuvant chemotherapy or radiation therapy. With no randomized controlled trials, the optimal management approach for children with spinal astrocytomas remains unclear. The aim of this study was to conduct a systematic review and meta-analysis on pediatric spinal astrocytomas.METHODSThe authors performed a systematic review of the PubMed/MEDLINE electronic database to investigate the impact of histological grade and extent of resection on overall survival among patients with spinal cord astrocytomas. They retained publications in which the majority of reported cases included astrocytoma histology.RESULTSTwenty-nine previously published studies met the eligibility criteria, totaling 578 patients with spinal cord astrocytomas. The spinal level of intramedullary spinal cord tumors was predominantly cervical (53.8%), followed by thoracic (40.8%). Overall, resection was more common than biopsy, and GTR was slightly more commonly achieved than STR (39.7% vs 37.0%). The reported rates of GTR and STR rose markedly from 1984 to 2015. Patients with high-grade astrocytomas had markedly worse 5-year overall survival than patients with low-grade tumors. Patients receiving GTR may have better 5-year overall survival than those receiving STR.CONCLUSIONSThe authors describe trends in the management of pediatric spinal cord astrocytomas and suggest a benefit of GTR over STR for 5-year overall survival.

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mentioning

confidence: 99%

Surgical outcomes of pediatric spinal cord astrocytomas: systematic review and meta-analysis

Azad¹,

Pendharkar²,

Pan³

et al. 2018

Journal of Neurosurgery: Pediatrics

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“…These factors contribute to a more aggressive clinical course in younger patients [ 28 ] and the histological aggressiveness with dural invasion [ 29 ] may explain the possible increase in dural complications. This differential behavior is similarly observed in intramedullary lesions which follow a more insidious course in younger populations and possibly presenting at a later, more advanced stage [ 30 , 31 ].…”

Section: Discussionmentioning

confidence: 73%

“…This differential behavior is similarly observed in intramedullary lesions which follow a more insidious course in younger populations and possibly presenting at a later, more advanced stage. 30,31 Intramedullary lesions were associated with a higher rate of CSF leak. Surgical resection of these lesions can be challenging due to the anatomical disruption of the spinal cord orientation and infiltrative lesions obscuring clear margins.…”

Section: Discussionmentioning

confidence: 99%

Predictors of Cerebrospinal Fluid Leak Following Dural Repair in Spinal Intradural Surgery

Jiang,

Budu,

Khan

et al. 2023

Neurospine

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Objective: We aim to compare the effectiveness of dural closure techniques in preventing cerebrospinal fluid (CSF) leaks following surgery for intradural lesions and seek to identify additional factors associated with CSF leaks. Surgical management of spinal intradural lesions involves durotomy which requires a robust repair to prevent postoperative CSF leakage. The ideal method of dural closure and the efficacy of sealants has not been established in literature.Methods: We performed a retrospective analysis of all intradural spinal cases performed at a tertiary spine centre from 1 April 2015 to 29 January 2020 and collected data on patient bio-profile, dural repair technique, and CSF leak rates. Multivariate analysis was performed to identify predictors for postoperative CSF leak.Results: A total of 169 cases were reported during the study period. There were 15 cases in which postoperative CSF leak was reported (8.87%). Multivariate analysis demonstrated that patient age (odds ratio [OR], 0.942; 95% confidence interval [CI], 0.891–0.996), surgical indication listed in the “others” category (OR, 44.608; 95% CI, 1.706–166.290) and dural closure with suture, sealant and patch (OR, 22.235; 95% CI, 2.578–191.798) were factors associated with CSF leak. Postoperative CSF leak was associated with the risk of surgical site infection with a likelihood ratio of 8.704 (χ² (1) = 14.633, p < 0.001).Conclusion: Identifying predictors for CSF leaks can assist in the counselling of patients with regard to surgical risk and expected postoperative recovery.

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“…Neurophysiological monitoring can also be used during resection of intramedullary spinal tumors by acquisition of data to confirm the integrity of neural pathways in the form of Motor evoked potentials (MEPs), D-waves and Somatosensory evoked potentials (SSEPs) ( 41 , 44 ).…”

Section: Operative Interventionmentioning

confidence: 99%

Pediatric Central Nervous System Tumors: State-of-the-Art and Debated Aspects

2018

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Pediatric neuro-oncology surgery continues to progress in sophistication, largely driven by advances in technology used to aid the following aspects of surgery: operative planning (advanced MRI techniques including fMRI and DTI), intraoperative navigation [preoperative MRI, intra-operative MRI (ioMRI) and intra-operative ultrasound (ioUS)], tumor visualization (microscopy, endoscopy, fluorescence), tumor resection techniques (ultrasonic aspirator, micro-instruments, micro-endoscopic instruments), delineation of the resection extent (ioMRI, ioUS, and fluorescence), and intraoperative safety (neurophysiological monitoring, ioMRI). This article discusses the aforementioned technological advances, and their multimodal use to optimize safe pediatric neuro-oncology surgery.

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Intramedullary tumors in children

Cited by 10 publications

References 43 publications

Surgical outcomes of pediatric spinal cord astrocytomas: systematic review and meta-analysis

Surgical outcomes of pediatric spinal cord astrocytomas: systematic review and meta-analysis

Predictors of Cerebrospinal Fluid Leak Following Dural Repair in Spinal Intradural Surgery

Pediatric Central Nervous System Tumors: State-of-the-Art and Debated Aspects

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