Surgical management of medulloblastoma

Sutton, Leslie N.; Phillips, Peter C.B.; Molloy, Patricia T.

doi:10.1007/bf00165514

Cited by 37 publications

(10 citation statements)

References 54 publications

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“…The surgical management of these tumors is determined by histological findings, because astrocytomas and ependymomas require total excision for cure, [23,24] whereas PNETs do not. [25] Currently, the decision whether to remove tumors from the brainstem is made on the basis of findings on intraoperative frozen sections, which may not be 100% accurate. [5,6,20,21] A preoperative neural network with complete diagnostic accuracy might replace intraoperative histological examination in guiding surgery and have the added advantage of allowing appropriate counseling of parents regarding surgical risk.…”

Section: Discussionmentioning

confidence: 99%

Prediction of posterior fossa tumor type in children by means of magnetic resonance image properties, spectroscopy, and neural networks

Arle

Morriss²,

Wang³

et al. 1997

FOC

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Recent studies have explored characteristics of brain tumors by means of magnetic resonance spectroscopy (MRS) to increase diagnostic accuracy and improve understanding of tumor biology. In this study, a computer-based neural network was developed to combine MRS data (ratios of N-acetyl-aspartate, choline, and creatine) with 10 characteristics of tumor tissue obtained from magnetic resonance (MR) studies, as well as tumor size and the patient's age and sex, in hopes of further improving diagnostic accuracy.Data were obtained in 33 children presenting with posterior fossa tumors. The cases were analyzed by a neuroradiologist, who then predicted the tumor type from among three categories (primitive neuroectodermal tumor, astrocytoma, or ependymoma/other) based only on the data obtained via MR imaging. These predictions were compared with those made by neural networks that had analyzed different combinations of the data. The neuroradiologist correctly predicted the tumor type in 73% of the cases, whereas four neural networks using different datasets as inputs were 58 to 95% correct. The neural network that used only the three spectroscopy ratios had the least predictive ability. With the addition of data including MR imaging characteristics, age, sex, and tumor size, the network's accuracy improved to 72%, consistent with the predictions of the neuroradiologist who was using the same information. Use of only the analog data (leaving out information obtained from MR imaging), resulted in 88% accuracy. A network that used all of the data was able to identify 95% of the tumors correctly. It is concluded that a neural network provided with imaging data, spectroscopic data, and a limited amount of clinical information can predict pediatric posterior fossa tumor type with remarkable accuracy.

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Section: Discussionmentioning

confidence: 99%

Prediction of posterior fossa tumor type in children by means of magnetic resonance image properties, spectroscopy, and neural networks

Arle

Morriss²,

Wang³

et al. 1997

FOC

Self Cite

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“…Relatively aggressive surgery is indicated because residual tumor larger than 1.5 cm 2 is considered a poor prognostic factor and places the patient in the high-risk category [5]. However, a less aggressive approach is justified if the preoperative spine magnetic resonance image (MRI) shows evidence of disease or if the tumor invades critical locations, such as the brainstem, cerebellar peduncles, or around cranial nerves [19]. • Controversy exists regarding the need for preoperative shunting of CSF in children with MB/PNET who have hydrocephalus.…”

Section: Treatmentmentioning

confidence: 98%

“…• A ventriculostomy or ventriculoperitoneal shunt may be indicated. There is concern regarding the potential for a shunt to spread tumor cells to the peritoneum, and filters to prevent this are often problematic [19]. • If MB/PNET is suspected on a preoperative scan of the brain and the patient is stable, an MRI of the entire spine should be obtained before surgery to assess for neuroaxis dissemination.…”

Section: Treatmentmentioning

confidence: 99%

“…• Controversy exists regarding the need for preoperative shunting of CSF in children with MB/PNET who have hydrocephalus. In most cases, it is safe to begin dexamethasone and excise the tumor, with or without CSF diversion, on the next elective operative day (with careful individualization to each particular case) [19]. • Hydrocephalus, bleeding, infarction, air embolism, aseptic meningitis, gastrointestinal hemorrhage, cervical instability, and occipital pseudomeningocele are all potential complications of surgery [19].…”

Section: Treatmentmentioning

confidence: 99%

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Medulloblastomas and central nervous system primitive neuroectodermal tumors

McLean

2003

Curr. Treat. Options in Oncol.

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Significant advances in the treatment of medulloblastoma and primitive neuroectodermal tumors have been made in the past three decades. Maximal surgical resection is a mainstay of therapy. However, unlike many other central nervous system neoplasms, medulloblastoma and primitive neuroectodermal tumors are radiation and chemotherapy responsive. Despite this response, the prognosis for patients with these tumors remains variable and is relatively poor in infants and patients with metastatic disease. These tumors most commonly arise in children, thus most clinical trials emphasize the reduction of long-term sequelae, in addition to improving survival. All newly diagnosed patients who are eligible should be offered participation in a clinical trial. If a patient is ineligible or declines consent/assent for a clinical trial, the best current treatment approach is surgical resection, followed by radiation therapy (except for children younger than 3 years) with weekly vincristine. For high-risk patients, 36 Gy of craniospinal irradiation should be delivered plus a boost of 19.8 Gy to the posterior fossa/primary tumor bed and sites of bulk metastatic disease. For average-risk patients, the craniospinal irradiation dose may be lowered to 23.4 Gy plus 32.4 Gy to the posterior fossa/tumor bed. After radiation therapy, intensive multimodal chemotherapy should be used for all patients.

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“…Surgical resection followed by systemic chemotherapy, bone marrow transplantation, and craniospinal radiation are the current mainstays of treatment [2]. Although MB usually presents as a single tumor of the cerebellum, dissemination throughout the leptomeninges is present in 25% of new cases and in 50% of recurrent cases.…”

Section: Introductionmentioning

confidence: 99%

Distinct patterns of human medulloblastoma dissemination in the developing chick embryo nervous system

Cage

Louie

Liu

et al. 2012

Clin Exp Metastasis

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Medulloblastoma (MB) is the most common malignant primary brain tumor in children. Aggressive tumors that disseminate along the leptomeninges carry extremely poor prognoses. Mechanisms that predict dissemination are poorly understood. Our objective was to develop a reliable and reproducible model to study MB dissemination. We have created a chicken-human xenograft to study features of MB with leptomeningeal dissemination. Human MB cell lines (D283, Daoy), primary human MB cells (SF8113), and primary genetic mouse model (Math1cre:SmoM2 flox/flox) MB cells were either transfected to express green fluorescent protein (GFP) or were labeled with a membrane permeable green fluorescent probe. Cells were then injected as aggregates or implanted as pellets into the developing chicken brain immediately after neural tube closure at embryonic day 2 (E2). Most embryos were harvested three days after implantation (E5) though some were harvested up to E15. The developing brain was analyzed via whole mount fluorescent imaging and tissue section immunohistochemistry. Human and mouse MBs survived in the developing chicken central nervous system (CNS). They exhibited distinct patterns of incorporation and dissemination into the CNS that were consistent with observed phenotypes of the corresponding human patient or mouse host. Specifically, metastatic D283 cells disseminated along the leptomeninges whereas Daoy, primary mouse MB, and primary human MB cells did not. This work supports an avian-human xenograft as a successful model to study patterns of MB dissemination. Our model provides a basis for manipulating cell signaling mechanisms to understand critical targets involved in MB dissemination.

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Surgical management of medulloblastoma

Cited by 37 publications

References 54 publications

Prediction of posterior fossa tumor type in children by means of magnetic resonance image properties, spectroscopy, and neural networks

Prediction of posterior fossa tumor type in children by means of magnetic resonance image properties, spectroscopy, and neural networks

Medulloblastomas and central nervous system primitive neuroectodermal tumors

Distinct patterns of human medulloblastoma dissemination in the developing chick embryo nervous system

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