Management of Tectal Glioma in Childhood

Stark, Andreas M.; Fritsch, Michael; Claviez, Alexander; Dörner, Lutz; Mehdorn, H. Maximilian

doi:10.1016/j.pediatrneurol.2004.12.014

Cited by 76 publications

(80 citation statements)

References 18 publications

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“…Tectal lesions may be indolent. Therefore, first line treatment consists of CSF diversion with no biopsy or further tumor-specific treatment in most cases [9][10][11]. Dorsally exophytic and focal pontomedullary lesions may be pathologically low grade and are frequently associated with long-term survival [12][13][14][15].…”

Section: Introductionmentioning

confidence: 99%

Favorable outcome with conservative treatment for children with low grade brainstem tumors

Fried¹,

Hawkins²,

Scheinemann³

et al. 2011

Pediatric Blood & Cancer

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BackgroundPediatric brainstem tumors (BST) comprise a heterogeneous group of entities. Data regarding treatment options and outcome of BST, specifically brainstem low grade tumors (BSLGT) are limited. In order to better define risk groups and evaluate treatment options for pediatric BST, we performed a comprehensive analysis of all BST patients treated in our hospital during the MRI era.ProceduresWe retrospectively analyzed clinical, imaging, and pathology data at presentation, treatment, and outcome of all BST patients followed at the Hospital for Sick Children in Toronto over the last 25 years.ResultsOf 1,801 children with brain tumors, 223 (12%) had a brainstem primary location. Tumors without pontine involvement were BSLGT in 98.3%, whereas 75% of tumors involving the pons were high grade (P = 0.0001). Patients with BSLGT had 5‐year progression‐free survival (PFS) and overall survival (OS) of 57 ± 3% and 89 ± 5%, respectively. Upfront observation of tumor residual conferred no survival disadvantage with 5‐year PFS and OS of 57 ± 5% and 93 ± 3%, respectively. In the group of patients requiring further treatment, 5‐year PFS and OS were comparable between chemotherapy and radiotherapy with 53 ± 12% and 93 ± 4% and 66 ± 11% and 83 ± 6%, respectively (P = 0.26 and 0.3, respectively).ConclusionBST without pontine involvement are almost invariably BSLGT. Children with BSLGT have an excellent outcome even with careful initial observation. No clear benefit was observed for radiotherapy over chemotherapy when adjuvant treatment was needed. A conservative approach may be warranted for children with non‐pontine brainstem lesions. Pediatr Blood Cancer 2012; 58: 556–560. © 2011 Wiley Periodicals, Inc.

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Section: Introductionmentioning

confidence: 99%

Favorable outcome with conservative treatment for children with low grade brainstem tumors

Fried¹,

Hawkins²,

Scheinemann³

et al. 2011

Pediatric Blood & Cancer

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“…3) The proposed management plan for the patient subgroup with tectal tumors includes appropriate cerebrospinal fluid diversion procedures with long-term neuroimaging follow up. 3,16) However, some cases with atypical neuroimaging and/or clinical progression and some exceptionally aggressive cases required further treatment, such as surgical resection or radiotherapy. 2,5,[7][8][9][14][15][16][18][19][20] In the present case, we decided to perform radical resection of the enhanced tumor because of the unusual aggressive clinical course with hemorrhage and the possibility of malignant components.…”

Section: Discussionmentioning

confidence: 99%

“…The overwhelming majority of tectal tumors are low-grade astrocytomas. [1][2][3]10,12,14,16) Accordingly, tectal tumors are often described as a distinctive subset of brain stem glioma with an unusually benign clinical course, and the diagnosis of`benign tectal glioma' is often based on the neuroimaging appearance and indolent clinical course of the lesion. 2,3,13,14) Here we describe a case of tectal pilocytic astrocytoma with the extremely unusual initial manifestation of intracranial hemorrhage.…”

Section: Introductionmentioning

confidence: 99%

Total Resection of a Hemorrhagic Tectal Pilocytic Astrocytoma-Case Report-

Oka

Yamashita

Kumabe

et al. 2007

Neurol. Med. Chir.(Tokyo)

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A 21-year-old man presented with a hemorrhagic pilocytic astrocytoma of the tectal plate manifesting as sudden onset of severe headache, vertigo, nausea, and vomiting. Computed tomography demonstrated acute hydrocephalus and hemorrhage within the brain stem and fourth ventricle. Magnetic resonance (MR) imaging revealed a dorsally exophytic tectal tumor as hypointense on the T 1 -weighted image and hyperintense on the T 2 -weighted image with contrast enhancement. Radical resection of the tumor was selected because of the unusual aggressive clinical course with hemorrhage and suspicion of malignant components. The tumor was totally resected via an occipital transtentorial approach using a neuronavigation system without surgical complications. The histological diagnosis was pilocytic astrocytoma. The patient was discharged home without neurological deficits on the 9th postoperative day. Twenty-three months after the surgery, follow-up MR imaging demonstrated no recurrence. Tectal plate pilocytic astrocytoma is rarely associated with hemorrhage but should be considered in the differential diagnosis of intracranial hemorrhage with acute presentation. Such exceptional tectal tumors should be resected radically and undergo histological examination to decide on further appropriate treatment.

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“…A recent study shows that this pattern is not only seen in children with brain structural abnormality and can be related to different aetiologies (4). Outcome is prevalently but not constantly unfavourable in patients with this phenomenon (4).…”

Section: Th January 2017mentioning

confidence: 99%

Poster Presentations

2016

Develop Med Child Neuro

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Objective: SCN9A Congenital Insensitivity to Pain (SCN-CIP) is a rare neurological condition that is challenging to manage, due to the potential accumulation of unrecognised / untreated injuries. The most dangerous period is early childhood, but with good multi-disciplinary management, children can lead very normal lives. We aimed to produce evidence-based, practical information for families, as well as professionals, on preventing disability through optimal management of this rare condition.Methods: An advanced search of the Medline database via PubMed was performed. This retrieved 142 hits, of which 35 were relevant and in English. 10 could not be retrieved. 15 were case reports, 7 original reports, and 3 review articles. By referring to citations, 3 additional relevant papers were identified and a total of 28 papers were analysed. In addition, the extensive clinical experience of Professor CG Woods-who runs a large research programme and clinic for SCN-CIP, contributed to our guidance. Results: Our results show that important areas for management are: self-inflicted injury, damage to bones and joints, injury to skin and injury to eyes. Prevention is paramount, and efficient ways to manage each of these areas were identified. Conclusions: Vigilance for, and prevention of, common problems in SCN-CIP is the most important aspect of management. Where injury occurs, prompt recognition and good management of complications is critical. For proper monitoring of individuals, we conclude that at a minimum a child should have a Lead Paediatrician, Lead Orthopaedic Surgeon, and a Lead Ophthalmologist. An expert in SCN-CIP to oversee care is ideal. We also conclude that parents require documentation of the diagnosis and contact details of the Lead Paediatrician that can be presented at A&E if required. We present a succinct, downloadable guide to optimal management for families and professionals. 002 13th January 2017 Duchenne muscular dystrophy audit

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Management of Tectal Glioma in Childhood

Cited by 76 publications

References 18 publications

Favorable outcome with conservative treatment for children with low grade brainstem tumors

Favorable outcome with conservative treatment for children with low grade brainstem tumors

Total Resection of a Hemorrhagic Tectal Pilocytic Astrocytoma-Case Report-

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