Clinical, radiologic and pathologic features and outcome following surgery for cervicomedullary gliomas in children

Introduction Surgical resection is generally recommended for cervicomedullary tumors, but morbidity of resection may be significant. This study sought to identify MRI characteristics that might predict morbidity and extent of resection. Materials and methods A retrospective review was performed of M...

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Published in:Child's nervous system 2009-11, Vol.25 (11), p.1401-1410
Main Authors: Di Maio, Salvatore, Gul, Shahid M., Cochrane, D. Douglas, Hendson, Glenda, Sargent, Michael A., Steinbok, Paul
Format: Article
Language:English
Subjects:
Brain Stem Neoplasms - pathology
Brain Stem Neoplasms - surgery
Brain Stem Neoplasms - therapy
Cervical Vertebrae
Chemotherapy, Adjuvant
Child
Child, Preschool
Cohort Studies
Female
Glioma - pathology
Glioma - surgery
Glioma - therapy
Humans
Infant
Magnetic Resonance Imaging
Male
Medicine
Medicine & Public Health
Medulla Oblongata - pathology
Medulla Oblongata - surgery
Neurons - pathology
Neurosciences
Neurosurgery
Original Paper
Radiotherapy, Adjuvant
Retrospective Studies
Treatment Outcome
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Summary:Introduction Surgical resection is generally recommended for cervicomedullary tumors, but morbidity of resection may be significant. This study sought to identify MRI characteristics that might predict morbidity and extent of resection. Materials and methods A retrospective review was performed of MRI findings, histopathology, extent, and morbidity of resection in cervicomedullary gliomas undergoing resection during 1985–2008. Results Of 78 brainstem tumors, nine cervicomedullary tumors undergoing resection were identified: two pilocytic astrocytomas, two gangliogliomas, and five grade II astrocytomas. Mean age was 6.3 years (range 1.7–11.2 years). Initial treatment was surgery in seven: biopsy (1), 80% in three and 30% in one. Conclusion A less aggressive initial surgical approach, supplemented by postoperative chemotherapy, designed to preserve brainstem function, is proposed for patients with interposed non-enhancing tissue continuous with normal cervical cord or medulla and/or a poorly defined ventral tumor/brainstem interface with abnormal low T1 signal extending beyond obvious tumor into the brainstem.
ISSN:0256-7040
1433-0350
DOI:10.1007/s00381-009-0956-x