Stereotactically-guided biopsies of brainstem tumors

León, Fernando Chico-Ponce de; Pérezpeña-Díazconti, Mario; Castro-Sierra, Eduardo; Guerrero-Jazo, F. J.; Gordillo-Domínguez, Luis Felipe; Gutiérrez-Guerra, R.; Salamanca, T.; Sosa-Sainz, G.; Santana-Montero, Blanca Lilia; DeMontesinos-Sampedro, A.

doi:10.1007/s00381-003-0737-x

Cited by 40 publications

(27 citation statements)

References 25 publications

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“…Other series have also highlighted the safety of this procedure in children, and the benefits outweigh the risks in patients who are appropriately selected to undergo this procedure [3,5,8,12,14,15] .…”

Section: Discussionmentioning

confidence: 99%

“…Since the report of Albright et al [1] , the general consensus has been to avoid performing a biopsy or surgical intervention in children with brain stem masses where the MRI characteristics are typical of a diffuse brain stem glioma [2,3,11,12,[14][15][16] . Typically, diffuse pontine gliomas in children appear as nonenhancing masses centered on the pons.…”

Section: Lack Of Correlation Between Histology and Tumor Behaviormentioning

confidence: 99%

“…Management on the basis of magnetic resonance imaging (MRI) diagnosis of diffuse pontine masses in children with typical clinical features is well accepted [1][2][3][4][5][6][7] , but some surgeons continue to perform biopsy of diffuse brain stem masses in children who are candidates for therapeutic trials or in the belief that histological diagnosis would alter management or provide prognostic indicators [8,9] . Several children with a pontine glioma might not have the typical MR or clinical features and others have brain stem masses with pathologies other than a pontine glioma [3,[10][11][12] . It is possibly in these patients that stereotactic biopsy has a role to play.…”

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confidence: 99%

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Status of Stereotactic Biopsy in Children with Brain Stem Masses: Insights from a Series of 106 Patients

Rajshekhar

Moorthy²

2010

Stereotact Funct Neurosurg

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Background:There is no consensus on the indications for stereotactic biopsy for brain stem masses in children. Objectives: We analyzed the results of stereotactic biopsy for brain stem masses in 106 consecutive children to define current indications for this surgery. Methods: We performed a retrospective review of inpatient summaries, stereotactic worksheets and radiological investigations of 106 consecutive patients, under the age of 18 years, who underwent CT-guided stereotactic biopsies for brain stem lesions between 1987 and 2008. Patients were divided into two eras: era I from 1987 to 1997 and era II from 1998 to 2008. Results: 91 children underwent a biopsy in era I, and 15 had the procedure in era II, this difference clearly indicating the impact of the availability of magnetic resonance imaging. There was no difference in the proportion of diffuse lesions biopsied in both eras. Astrocytoma was the most frequently diagnosed pathology in both eras accounting for nearly 90% of biopsies. Inflammatory masses were diagnosed in less than 10% of patients. There was no mortality or permanent morbidity. Mortality, on follow-up, in children with diffuse low- and high-grade astrocytoma was similar. Conclusions:CT-guided stereotactic biopsy for brain stem masses in children is safe and is presently indicated in ruling out an inflammatory pathology of an enhancing mass of the brain stem.

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Section: Discussionmentioning

confidence: 99%

Section: Lack Of Correlation Between Histology and Tumor Behaviormentioning

confidence: 99%

mentioning

confidence: 99%

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Status of Stereotactic Biopsy in Children with Brain Stem Masses: Insights from a Series of 106 Patients

Rajshekhar

Moorthy²

2010

Stereotact Funct Neurosurg

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“…They are characteristically malignant fibrillary astrocytomas (WHO grades III and IV), although other entities have been reported. [123][124][125][126] The long-term survival is very poor with only 6 to 10% of patients surviving beyond 2 years of age, which has not changed over the last decades. 127 Historical control data are relatively homogeneous among several trials and reveal 1-year OS of 30% (Ϯ 3%) and 1-year PFS of 12% (Ϯ 2%), which against new therapeutics avenues will be tested.…”

Section: Diffuse Brain Stem Gliomamentioning

confidence: 99%

Pediatric Brain Tumors: Current Treatment Strategies and Future Therapeutic Approaches

2009

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Summary:Pediatric CNS tumors are the most common solid tumors of childhood and the second most common cancer after hematological malignancies accounting for approximate 20 to 25% of all primary pediatric tumors. With over 3,000 new cases per year in the United States, childhood CNS tumors are the leading cause of death related to cancer in this population. The prognosis for these patients has improved over the last few decades, but current therapies continue to carry a high risk of significant side effects, especially for the very young. Currently a combination of surgery, radiation, and chemotherapy is often used in children greater than 3 years of age. This article will outline current and future therapeutic strategies for the most common pediatric CNS tumors, including primitive neuroectodermal tumors such as medulloblastoma, as well as astrocytomas and ependymomas.

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“…There is no consensus imaging definition of DIPG, however, most agree that the typical imaging appearance of these lesions includes an intrinsic location, involvement of more than 50% of the axial diameter of the pons, indistinct margins, T1 hypointensity, T2 hyperintensity, irregular to no enhancement, and the absence of cystic components [4]. Most children with a diagnosis of DIPG are treated with radiation therapy, as few studies have shown any survival benefit using concurrent or adjuvant chemotherapeutic regimen [4,5,6]. Even with optimal radiation therapy, children with DIPG have an extremely poor prognosis, with a median survival between 9 and 12 months.…”

Section: Introductionmentioning

confidence: 99%

Diffuse Pontine Lesions in Children with Neurofibromatosis Type 1: Making a Case for Unidentified Bright Objects

et al. 2013

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Using an illustrative case of a presumed pontine unidentified bright object (UBO) with spontaneous lesion regression over 2 years, we review the importance of including UBOs in the differential diagnosis of children with confirmed or possible neurofibromatosis type 1 (NF1) who present with diffuse pontine enlargement and T2-weighted changes on MRI. Asymptomatic children with presumed NF1 and diffuse pontine lesions should not be treated with radiation and should not be biopsied. Prior reports of good prognosis associated with pontine glioma in patients with NF1 may have been unrecognized UBOs in some cases.

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Stereotactically-guided biopsies of brainstem tumors

Cited by 40 publications

References 25 publications

Status of Stereotactic Biopsy in Children with Brain Stem Masses: Insights from a Series of 106 Patients

Status of Stereotactic Biopsy in Children with Brain Stem Masses: Insights from a Series of 106 Patients

Pediatric Brain Tumors: Current Treatment Strategies and Future Therapeutic Approaches

Diffuse Pontine Lesions in Children with Neurofibromatosis Type 1: Making a Case for Unidentified Bright Objects

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