Neurosurgical treatment of pediatric low-grade midbrain tumors: a single consecutive institutional series of 15 patients
Neurosurgical treatment of pediatric low-grade midbrain tumors: a single consecutive institutional series of 15 patients
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DOI：
10.3171/2014.9.peds1462
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发表时间：
2014-12-01
影响因子：
1.9
通讯作者：
Due-Tonnessen, Paulina
中科院分区：
文献类型：
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作者：
Lundar, Tryggve;Due-Tonnessen, Bernt Johan;Due-Tonnessen, Paulina
物体。作者描述了手术治疗儿童低级别中脑胶质瘤的远期疗效。方法：研究方法。在1989-2010年间，连续15名年龄在0-15岁之间的低级别中脑胶质瘤患者接受了原发肿瘤切除术，这些患者的手术发病率、死亡率、学业成就和/或工作参与度被纳入这项回顾研究。按Barthel指数对患者的粗大运动功能和日常生活活动能力进行评分。在15名患者中，10名患者在手术时处于第一个十年(年龄P-9岁)，5名患者在第二个十年(年龄10-15岁)。男女之比为0.50(5：10)。无一例患者失访。1例患者在术后期间(治疗后32天)死亡。另有2例患者在随访过程中死亡。1例患者术后8个月死于切除腔内急性出血，另1例患者在首次治疗21年后死于分流失败。在撰写本文时，已有12名患者存活，随访期从3年到24年(中位数8年)。在12名幸存者中，11名患者的Barthel指数评分正常(100分)，1名患者的Barthel指数评分为80分。共进行了25例肿瘤切除。在1例患者中，由于MRI证实肿瘤残留，在初次切除5天后再次切除。另有5例患者在初次手术后3个月至4年内因MRI证实的进展性肿瘤疾病和临床恶化而再次手术切除肿瘤。这5名患者中有3名还接受了第三次切除，3名患者中有1名接受了第四次手术。6例患儿接受辅助治疗：局部放疗2例，化疗3例，两者均为1例。15例患者中有12例(80%)因持续性脑积水需要治疗。选定的低级别中脑胶质瘤可以明显受益于切除，效果良好，即使在较长时间内也是如此。本系列中有三名患者死亡，其中一名患者的生存期延长了21年。在12名幸存者中，至少有9名患者可以获得稳定的长期结果。1名患者在初次切除后8个月死于急性出血；否则，没有观察到肿瘤的快速进展和死亡。40%的患者接受了辅助治疗，包括局部放疗、化疗或两者兼而有之。
Object. The authors delineate the long-term results of surgical treatment for pediatric low-grade midbrain glioma. Methods. A series of 15 consecutive patients (age range 0-15 years) who underwent primary tumor resection for a low-grade midbrain glioma during the years 1989-2010 were included in this retrospective study on surgical morbidity, mortality rate, academic achievement, and/or work participation. Gross motor function and activities of daily living were scored according to the Barthel Index.Results. Of the 15 patients, 10 were in their 1st decade (age P-9 years) and 5 were in their 2nd decade of life (age 10-15 years) at the time of surgery. The male/female ratio was 0.50 (5:10). No patients were lost to follow-up. One patient died in the postoperative period (32 days posttreatment). Another 2 patients died during follow-up. One patient succumbed to acute bleeding in the resection cavity 8 months after surgery, and the other died of shunt failure 21 years after initial treatment. Twelve patients are alive at the time of this writing, with follow-up periods from 3 to 24 years (median 8 years).Among the 12 survivors, the Barthel Index scores were normal (100) in 11 patients and 80 in 1 patient. A total of 25 tumor resections were performed. In 1 patient, further resection was performed 5 days after initial resection due to MRI-confirmed residual tumor. Another 5 patients underwent repeat tumor resection after MRI-confirmed progressive tumor disease and clinical deterioration ranging from 3 months to 4 years after the initial operation. Three of these 5 patients also underwent a third resection, and 1 of the 3 underwent a fourth operation. Six children received adjuvant therapy: local radiotherapy in 2 patients, chemotherapy in 3 patients, and both in 1 patient. Twelve (80%) of the 15 patients needed treatment for persistent hydrocephalus.Conclusions. Selected cases of low-grade midbrain gliomas may clearly benefit from resection with favorable results, even for prolonged periods. Three patients in the present series died, one of whom had a prolonged survival period of 21 years. Among the 12 survivors, stable long-term results appeared obtainable in at least 9. One patient died of acute hemorrhage 8 months after initial resection; otherwise, rapid tumor progression and death were not observed. Forty percent of the patients received adjuvant treatment, with local radiotherapy, chemotherapy, or both.