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Reyes Soto G, Murillo Ponce C, Catillo-Rangel C, Cacho Diaz B, Nurmukhametov R, Chmutin G, Natalaja Mukengeshay J, Mpoyi Tshiunza C, Ramirez MDJE, Montemurro N. Intraoperative Ultrasound: An Old but Ever New Technology for a More Personalized Approach to Brain Tumor Surgery. Cureus 2024; 16:e62278. [PMID: 39006708 PMCID: PMC11246190 DOI: 10.7759/cureus.62278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2024] [Indexed: 07/16/2024] Open
Abstract
BACKGROUND Although the use of transcranial ultrasound dates to the mid-20th century, the main purpose of this research work is to standardize its use in the resection of brain tumors. This is due to its wide availability, low cost, lack of contraindications, and absence of harmful effects for the patient and medical staff, along with the possibility of real-time verification of the complete resection of tumor lesions and minimization of vascular injuries or damage to adjacent structures. METHODS A retrospective study was conducted from June to December 2022. The study included eight patients (three men and five women) aged between 32 and 76 years. Histological examination revealed two high-grade gliomas, one low-grade glioma, and five metastatic lesions. RESULTS The low-grade glioma appeared as a homogeneously echogenic structure and easily distinguishable from brain parenchyma, whereas metastases and high-grade gliomas showed higher echogenicity, being identified as malignant lesions due to areas of low echogenicity necrosis and peritumoral edema identified as a hyperechogenic structure. CONCLUSIONS The use of intraoperative transcranial ultrasound constitutes an important tool for neurosurgeons during tumor resection. Although it is easy to use, intraoperative ultrasound requires a relatively short learning curve and a good understanding of the fundamentals of ultrasound. Its main advantage over neuronavigation is that it is not affected by the "brain shift" phenomenon that commonly occurs during tumor resection, since the ultrasound images are updated during surgery.
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Affiliation(s)
- Gervith Reyes Soto
- Neurosurgical Oncology, Instituto Nacional de Cancerología, Mexico City, MEX
| | | | - Carlos Catillo-Rangel
- Neurosurgery, Hospital Regional 1ro de Octubre (ISSSTE or Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado), Mexico City, MEX
| | | | - Renat Nurmukhametov
- Neurosurgery, 2nd National Clinical Centre of Federal State Budgetary Research Institution (Russian Research Center of Surgery named after Academician B.V. Petrovsky), Moscow, RUS
| | - Gennady Chmutin
- Neurosurgery, Peoples' Friendship University of Russia (RUDN University), Moscow, RUS
| | | | | | | | - Nicola Montemurro
- Neurosurgery, Azienda Ospedaliera Universitaria Pisana (AOUP) University of Pisa, Pisa, ITA
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Watanabe G, Conching A, Fry L, Putzler D, Khan MF, Haider MA, Haider AS, Ferini G, Rodriguez-Beato FY, Sharma M, Umana GE, Palmisciano P. Intraventricular Glioma in Pediatric Patients: A Systematic Review of Demographics, Clinical Characteristics, and Outcomes. World Neurosurg 2024; 186:252-262.e10. [PMID: 38608813 DOI: 10.1016/j.wneu.2024.04.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 04/04/2024] [Indexed: 04/14/2024]
Abstract
OBJECTIVE We conducted a systematic review on pediatric intraventricular gliomas to survey the patient population, tumor characteristics, management, and outcomes. METHODS PubMed, Scopus, Web-of-Science, and Cochrane were searched using PRISMA guidelines to include studies reporting pediatric patients with intraventricular gliomas. RESULTS A total of 30 studies with 317 patients were included. Most patients were male (54%), diagnosed at a mean age of 8 years (0.2-19), and frequently exhibited headache (24%), nausea and vomiting (21%), and seizures (15%). Tumors were predominantly located in the fourth (48%) or lateral ventricle (44%). Most tumors were WHO grade 1 (68%). Glioblastomas were rarely reported (2%). Management included surgical resection (97%), radiotherapy (27%), chemotherapy (8%), and cerebrospinal fluid diversion for hydrocephalus (38%). Gross total resection was achieved in 59% of cases. Cranial nerve deficit was the most common postsurgical complication (28%) but most were reported in articles published prior to the year 2000 (89%). Newer cases published during or after the year 2000 exhibited significantly higher rates of gross total resection (78% vs. 39%, P < 0.01), lower rates of recurrence (26% vs. 47%, P < 0.01), longer average overall survival time (42 vs. 21 months, P = 0.02), and a higher proportion of patients alive (83% vs. 70%, P = 0.03) than in older cases. CONCLUSIONS Pediatric intraventricular gliomas correlate with parenchymal pediatric gliomas in terms of age at diagnosis and general outcomes. The mainstay of management is complete surgical excision and more recent studies report longer overall survival rates and less cranial nerve complications.
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Affiliation(s)
- Gina Watanabe
- University of Hawaii at Manoa John A. Burns School of Medicine, Honolulu, Hawaii, USA.
| | - Andie Conching
- University of Hawaii at Manoa John A. Burns School of Medicine, Honolulu, Hawaii, USA
| | - Lane Fry
- University of Kansas School of Medicine, Kansas City, Kansas, USA
| | - Dillon Putzler
- University of Hawaii at Manoa John A. Burns School of Medicine, Honolulu, Hawaii, USA
| | | | | | - Ali S Haider
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Gianluca Ferini
- Department of Radiation Oncology, REM Radioterapia srl, Viagrande, Italy
| | | | - Mayur Sharma
- Department of Neurosurgery, University of Minnesota, Minneapolis, Minnesota, USA
| | | | - Paolo Palmisciano
- Department of Neurological Surgery, University of California, Davis, Sacramento, California, USA
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3
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Adegboyega G, Jesuyajolu D, Sakaiwa N, Ogunfolaji O, Fadalla T, SaedAli Emhemed M, Shituluka M, Dada OE, Ugorji C, Negida A, Abu-Bonsrah N. The Landscape of Neurosurgical Oncology Adjunct Usage in Africa: A Scoping Review. World Neurosurg 2024; 183:e632-e637. [PMID: 38191056 DOI: 10.1016/j.wneu.2023.12.159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 12/28/2023] [Accepted: 12/30/2023] [Indexed: 01/10/2024]
Abstract
BACKGROUND Intraoperative neurosurgical adjuncts improve extent of resection whilst mitigating patient morbidity. The delivery of neurosurgical care via these adjuncts is the norm in high-income countries, but there is yet to be a study highlighting the usage of neurosurgical oncology adjuncts in Africa. This paper aims to provide awareness of the use of these adjuncts in Africa, reasons for limited procurement, and possible solutions to the problem. METHODS This scoping review was conducted in accordance with Preferred Reporting Items for Systematic Review and Meta-Analysis Extension for Scoping Reviews guidelines. Semantic derivatives of neurosurgical oncology, adjuncts, and Africa were applied to medical databases. Studies in Africa with outcomes relating to adjunct usage, morbidity, mortality, and quality of life were selected. Book chapters and reviews were excluded. RESULTS Thirteen studies with 287 patients (0.5 to 74 years) were included in the final analysis. Most studies were cohort observational (46.2%) and originated from South Africa (46.2%). Meningioma was the most prevalent tumor histology (39.4%), and neuronavigation was the most readily used adjunct for surgical resection (30.8%). Using adjuncts, gross total resection was achieved in close to half the patient cohort (49.8%). Limited technology, lack of experience, cost of equipment, and inconsistency in power supply were noted as factors contributing to lack of adjunct usage. CONCLUSIONS Neurosurgical adjuncts provide significant benefits in neurosurgical oncology. There is limited utilization of intraoperative adjuncts in most of Africa owing to limited resources and experienced professionals. Bilateral partnerships with a focus on donation and education will foster safe and sustainable adjunct incorporation in Africa.
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Affiliation(s)
- Gideon Adegboyega
- Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon; Department of Clinical Neurosciences, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom.
| | - Damilola Jesuyajolu
- Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon; Department of Neurosurgery, Manchester Foundation NHS Trust, England, United Kingdom
| | - Neontle Sakaiwa
- Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon; Department of Medicine, University of Botswana School of Medicine, Gaborone, Botswana
| | - Oloruntoba Ogunfolaji
- Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon; Department of Clinical Medicine, The State Hospital, Oyo State, Nigeria
| | - Tarig Fadalla
- Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon; Soba University Hospital, University of Khartoum, Khartoum, Sudan
| | - Marwa SaedAli Emhemed
- Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon; Faculty of Medicine, University of Tripoli, Tripoli, Libya
| | - Musakanya Shituluka
- Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon; Research Department, Association of Future African Neurosurgeons, Lusaka, Zambia
| | - Olaoluwa Ezekiel Dada
- Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon; College of Medicine, Universissssty of Ibadan, Ibadan, Oyo State, Nigeria
| | - Chiazam Ugorji
- Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon
| | - Ahmed Negida
- Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon; Department of Neurology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Nancy Abu-Bonsrah
- Research Department, Association of Future African Neurosurgeons, Yaounde, Cameroon; Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland, USA
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El Beltagy MA, Elbaroody M. The Value of Intraoperative Ultrasound in Brain Surgery. Adv Tech Stand Neurosurg 2024; 50:185-199. [PMID: 38592531 DOI: 10.1007/978-3-031-53578-9_6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/10/2024]
Abstract
Favorable clinical outcomes in adult and pediatric neurosurgical oncology generally depend on the extent of tumor resection (EOR). Maximum safe resection remains the main aim of surgery in most intracranial tumors. Despite the accuracy of intraoperative magnetic resonance imaging (iMRI) in the detection of residual intraoperatively, it is not widely implemented worldwide owing to enormous cost and technical difficulties. Over the past years, intraoperative ultrasound (IOUS) has imposed itself as a valuable and reliable intraoperative tool guiding neurosurgeons to achieve gross total resection (GTR) of intracranial tumors.Being less expensive, feasible, doesn't need a high level of training, doesn't need a special workspace, and being real time with outstanding temporal and spatial resolution; all the aforementioned advantages give a superiority for IOUS in comparison to iMRI during resection of brain tumors.In this chapter, we spot the light on the technical nuances, advanced techniques, outcomes of resection, pearls, and pitfalls of the use of IOUS during the resection of brain tumors.
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Affiliation(s)
- Mohamed A El Beltagy
- Neurosurgery Department, Kasr Alainy School of Medicine, Cairo University, Cairo, Egypt
- Neurosurgery Department, Children's Cancer Hospital Egypt (CCHE, 57357), Cairo, Egypt
| | - Mohammad Elbaroody
- Neurosurgery Department, Kasr Alainy School of Medicine, Cairo University, Cairo, Egypt
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Osuna-Marco MP, Martín-López LI, Tejera ÁM, López-Ibor B. Questions and answers in the management of children with medulloblastoma over the time. How did we get here? A systematic review. Front Oncol 2023; 13:1229853. [PMID: 37456257 PMCID: PMC10340518 DOI: 10.3389/fonc.2023.1229853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 06/13/2023] [Indexed: 07/18/2023] Open
Abstract
Introduction Treatment of children with medulloblastoma (MB) includes surgery, radiation therapy (RT) and chemotherapy (CT). Several treatment protocols and clinical trials have been developed over the time to maximize survival and minimize side effects. Methods We performed a systematic literature search in May 2023 using PubMed. We selected all clinical trials articles and multicenter studies focusing on MB. We excluded studies focusing exclusively on infants, adults, supratentorial PNETs or refractory/relapsed tumors, studies involving different tumors or different types of PNETs without differentiating survival, studies including <10 cases of MB, solely retrospective studies and those without reference to outcome and/or side effects after a defined treatment. Results 1. The main poor-prognosis factors are: metastatic disease, anaplasia, MYC amplification, age younger than 36 months and some molecular subgroups. The postoperative residual tumor size is controversial.2. MB is a collection of diseases.3. MB is a curable disease at diagnosis, but survival is scarce upon relapse.4. Children should be treated by experienced neurosurgeons and in advanced centers.5. RT is an essential treatment for MB. It should be administered craniospinal, early and without interruptions.6. Craniospinal RT dose could be lowered in some low-risk patients, but these reductions should be done with caution to avoid relapses.7. Irradiation of the tumor area instead of the entire posterior fossa is safe enough.8. Hyperfractionated RT is not superior to conventional RT9. Both photon and proton RT are effective.10. CT increases survival, especially in high-risk patients.11. There are multiple drugs effective in MB. The combination of different drugs is appropriate management.12. CT should be administered after RT.13. The specific benefit of concomitant CT to RT is unknown.14. Intensified CT with stem cell rescue has no benefit compared to standard CT regimens.15. The efficacy of intraventricular/intrathecal CT is controversial.16. We should start to think about incorporating targeted therapies in front-line treatment.17. Survivors of MB still have significant side effects. Conclusion Survival rates of MB improved greatly from 1940-1970, but since then the improvement has been smaller. We should consider introducing targeted therapy as front-line therapy.
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Affiliation(s)
- Marta P. Osuna-Marco
- Pediatric Oncology Unit, Centro Integral Oncológico Clara Campal (CIOCC), Hospital Universitario HM Montepríncipe, HM Hospitales, Madrid, Spain
- Faculty of Experimental Sciences, Universidad Francisco de Vitoria, Madrid, Spain
| | - Laura I. Martín-López
- Pediatric Oncology Unit, Centro Integral Oncológico Clara Campal (CIOCC), Hospital Universitario HM Montepríncipe, HM Hospitales, Madrid, Spain
| | - Águeda M. Tejera
- Faculty of Experimental Sciences, Universidad Francisco de Vitoria, Madrid, Spain
| | - Blanca López-Ibor
- Pediatric Oncology Unit, Centro Integral Oncológico Clara Campal (CIOCC), Hospital Universitario HM Montepríncipe, HM Hospitales, Madrid, Spain
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Frassanito P, Stifano V, Bianchi F, Tamburrini G, Massimi L. Enhancing the Reliability of Intraoperative Ultrasound in Pediatric Space-Occupying Brain Lesions. Diagnostics (Basel) 2023; 13:diagnostics13050971. [PMID: 36900115 PMCID: PMC10000977 DOI: 10.3390/diagnostics13050971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 02/24/2023] [Accepted: 02/28/2023] [Indexed: 03/08/2023] Open
Abstract
INTRODUCTION Intraoperative ultrasound (IOUS) may aid the resection of space-occupying brain lesions, though technical limits may hinder its reliability. METHODS IOUS (MyLabTwice®, Esaote, Italy) with a microconvex probe was utilized in 45 consecutive cases of children with supratentorial space-occupying lesions aiming to localize the lesion (pre-IOUS) and evaluate the extent of resection (EOR, post-IOUS). Technical limits were carefully assessed, and strategies to enhance the reliability of real-time imaging were accordingly proposed. RESULTS Pre-IOUS allowed us to localize the lesion accurately in all of the cases (16 low-grade gliomas, 12 high-grade gliomas, eight gangliogliomas, seven dysembryoplastic neuroepithelial tumors, five cavernomas, and five other lesions, namely two focal cortical dysplasias, one meningioma, one subependymal giant cell astrocytoma, and one histiocytosis). In 10 deeply located lesions, IOUS with hyperechoic marker, eventually coupled with neuronavigation, was useful to plan the surgical route. In seven cases, the administration of contrast ensured a better definition of the vascular pattern of the tumor. Post-IOUS allowed the evaluation of EOR reliably in small lesions (<2 cm). In large lesions (>2 cm) assessing EOR is hindered by the collapsed surgical cavity, especially when the ventricular system is opened, and by artifacts that may simulate or hide residual tumors. The main strategies to overcome the former limit are inflation of the surgical cavity through pressure irrigation while insonating, and closure of the ventricular opening with Gelfoam before insonating. The strategies to overcome the latter are avoiding the use of hemostatic agents before IOUS and insonating through normal adjacent brain instead of corticotomy. These technical nuances enhanced the reliability of post-IOUS, with a total concordance to postoperative MRI. Indeed, the surgical plan was changed in about 30% of cases, as IOUS showed a residual tumor that was left behind. CONCLUSION IOUS ensures reliable real-time imaging in the surgery of space-occupying brain lesions. Limits may be overcome with technical nuances and proper training.
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Affiliation(s)
- Paolo Frassanito
- Pediatric Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Vito Stifano
- Pediatric Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
- Institute of Neurosurgery, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- Correspondence: ; Tel.: +39-0630154587
| | - Federico Bianchi
- Pediatric Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
- Institute of Neurosurgery, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Gianpiero Tamburrini
- Pediatric Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
- Institute of Neurosurgery, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Luca Massimi
- Pediatric Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
- Institute of Neurosurgery, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
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Yang W, Li Y, Ying Z, Cai Y, Peng X, Sun H, Chen J, Zhu K, Hu G, Peng Y, Ge M. A presurgical voxel-wise predictive model for cerebellar mutism syndrome in children with posterior fossa tumors. Neuroimage Clin 2023; 37:103291. [PMID: 36527996 PMCID: PMC9791171 DOI: 10.1016/j.nicl.2022.103291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 12/04/2022] [Accepted: 12/12/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND This study aimed to investigate cerebellar mutism syndrome (CMS)-related voxels and build a voxel-wise predictive model for CMS. METHODS From July 2013 to January 2022, 188 pediatric patients diagnosed with posterior fossa tumor were included in this study, including 38 from a prospective cohort recruited between 2020 and January 2022, and the remaining from a retrospective cohort recruited in July 2013-Aug 2020. The retrospective cohort was divided into the training and validation sets; the prospective cohort served as a prospective validation set. Voxel-based lesion symptoms were assessed to identify voxels related to CMS, and a predictive model was constructed and tested in the validation and prospective validation sets. RESULTS No significant differences were detected among these three data sets in CMS rate, gender, age, tumor size, tumor consistency, presence of hydrocephalus and paraventricular edema. Voxels related to CMS were mainly located in bilateral superior and inferior cerebellar peduncles and the superior part of the cerebellum. The areas under the curves for the model in the training, validation and prospective validation sets were 0.889, 0.784 and 0.791, respectively. CONCLUSIONS Superior and inferior cerebellar peduncles and the superior part of the cerebellum were related to CMS, especially the right side, and voxel-based lesion-symptom analysis could provide valuable predictive information before surgery.
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Affiliation(s)
- Wei Yang
- Department of Neurosurgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - Yiming Li
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
| | - Zesheng Ying
- Department of Neurosurgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - Yingjie Cai
- Department of Neurosurgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - Xiaojiao Peng
- Department of Neurosurgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - HaiLang Sun
- Department of Neurosurgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - Jiashu Chen
- Department of Neurosurgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - Kaiyi Zhu
- Department of Cardiology, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi Medical University, Taiyuan 030032, China; Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 030032, China
| | - Geli Hu
- Department of Clinical and Technical Support, Philips Healthcare, Beijing 100600, China
| | - Yun Peng
- Department of Image Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China.
| | - Ming Ge
- Department of Neurosurgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China.
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Intraoperative MRI versus intraoperative ultrasound in pediatric brain tumor surgery: is expensive better than cheap? A review of the literature. Childs Nerv Syst 2022; 38:1445-1454. [PMID: 35511271 DOI: 10.1007/s00381-022-05545-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 04/25/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE The extent of brain tumor resection (EOR) is a fundamental prognostic factor in pediatric neuro-oncology in association with the histology. In general, resection aims at gross total resection (GTR). Intraoperative imaging like intraoperative US (iOUS) and MRI have been developed in order to find any tumoral remnant but with different costs. Aim of our work is to review the current literature in order to better understand the differences between costs and efficacy of MRI and iOUS to evaluate tumor remnants intraoperatively. METHODS We reviewed the existing literature on PubMed until 31st December 2021 including the sequential keywords "intraoperative ultrasound and pediatric brain tumors", "iUS and pediatric brain tumors", "intraoperative magnetic resonance AND pediatric brain tumors", and "intraoperative MRI AND pediatric brain tumors. RESULTS A total of 300 papers were screened through analysis of title and abstract; 254 were excluded. After selection, a total of 23 articles were used for this systematic review. Among the 929 patients described, a total of 349(38%) of the cases required an additional resection after an iMRI scan. GTR was measured on 794 patients (data of 69 patients lost), and it was achieved in 552(70%) patients. In case of iOUS, GTR was estimated in 291 out of 379 (77%) cases. This finding was confirmed at the post-operative MRI in 256(68%) cases. CONCLUSIONS The analysis of the available literature demonstrates that expensive equipment does not always mean better. In fact, for the majority of pediatric brain tumors, iOUS is comparable to iMRI in estimating the EOR.
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Navarro SM, Shaikh H, Abdi H, Keil EJ, Odusanya S, Stewart KA, Tuyishime E, Mazingi D, Tuttle TM. Surgical applications of ultrasound use in low‐ and
middle‐income
countries: A systematic review. Australas J Ultrasound Med 2022; 25:80-97. [DOI: 10.1002/ajum.12302] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Affiliation(s)
- Sergio M. Navarro
- Department of Surgery University of Minnesota 420 Delaware Street SE Minneapolis MN 55455 USA
| | - Hashim Shaikh
- Department of Orthopaedics University of Rochester 601 Elmwood Avenue Rochester NY 14642 USA
| | - Hodan Abdi
- Department of Surgery University of Minnesota 420 Delaware Street SE Minneapolis MN 55455 USA
| | - Evan J. Keil
- Department of Surgery University of Minnesota 420 Delaware Street SE Minneapolis MN 55455 USA
| | - Simisola Odusanya
- Department of Surgery University of Minnesota 420 Delaware Street SE Minneapolis MN 55455 USA
| | - Kelsey A. Stewart
- Department of Anaesthesia, Critical Care, and Emergency Medicine University of Rwanda KN 4 Ave Kigali Rwanda
| | - Eugene Tuyishime
- Department of Anaesthesia University of Toronto 123 Edward Street Toronto ON M5G 1E2 Canada
- Department of Obstetrics and Gyenecology University of Minnesota 420 Delaware Street SE Minneapolis MN 55455 USA
| | - Dennis Mazingi
- Department of Surgery University of Zimbabwe Mazowe Street A168 Harare Zimbabwe
| | - Todd M. Tuttle
- Department of Surgery University of Minnesota 420 Delaware Street SE Minneapolis MN 55455 USA
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Pettersson SD, Kitlinski M, Miękisiak G, Ali S, Krakowiak M, Szmuda T. Risk factors for postoperative cerebellar mutism syndrome in pediatric patients: a systematic review and meta-analysis. J Neurosurg Pediatr 2022; 29:467-475. [PMID: 34972081 DOI: 10.3171/2021.11.peds21445] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 11/04/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE A review article assessing all the risk factors reported in the literature for postoperative cerebellar mutism syndrome (pCMS) among children remains absent. The authors sought to perform a systematic review and meta-analysis to evaluate this issue. METHODS PubMed, Embase, and Web of Science were queried to systematically extract potential references. The articles relating to pCMS were required to be written in the English language, involve pediatric patients (≤ 18 years of age), and provide extractable data, which included a comparison group of patients who did not develop pCMS. The quality of the included studies was evaluated using the Newcastle-Ottawa Scale. Data were pooled using RevMan 5.4, and publication bias was assessed by visual inspection for funnel plot asymmetry. The study protocol was registered through PROSPERO (ID: CRD42021256177). RESULTS Overall, 28 studies involving 2276 patients were included. Statistically significant risk factors identified from univariate analysis were brainstem invasion (OR 4.28, 95% CI 2.23-8.23; p < 0.0001), fourth ventricle invasion (OR 12.84, 95% CI 4.29-38.44; p < 0.00001), superior cerebellar peduncle invasion (OR 6.77, 95% CI 2.35-19.48; p = 0.0004), diagnosis of medulloblastoma (OR 3.26, 95% CI 1.93-5.52; p < 0.0001), medulloblastoma > 50 mm (OR 8.85, 95% CI 1.30-60.16; p = 0.03), left-handedness (OR 6.57, 95% CI 1.25-34.44; p = 0.03), and a vermis incision (OR 5.44, 95% CI 2.09-14.16; p = 0.0005). On the other hand, a tumor located in the cerebellar hemisphere (OR 0.23, 95% CI 0.06-0.92; p = 0.04), cerebellar hemisphere compression (OR 0.23, 95% CI 0.11-0.45; p < 0.0001), and intraoperative imaging (OR 0.36, 95% CI 0.18-0.72; p = 0.004) reduced the risk of pCMS. CONCLUSIONS This study provides the largest and most reliable review of risk factors associated with pCMS. Although some risk factors may be dependent on one another, the data may be used by surgeons to better identify patients at risk for pCMS and for intervention planning.
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Affiliation(s)
- Samuel D Pettersson
- 1Scientific Circle of Neurology and Neurosurgery, Neurosurgery Department, Medical University of Gdansk
| | - Michael Kitlinski
- 1Scientific Circle of Neurology and Neurosurgery, Neurosurgery Department, Medical University of Gdansk
| | | | - Shan Ali
- 3Neurology Department, Mayo Clinic, Jacksonville, Florida
| | - Michał Krakowiak
- 4Neurosurgery Department, Medical University of Gdansk, Poland; and
| | - Tomasz Szmuda
- 4Neurosurgery Department, Medical University of Gdansk, Poland; and
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Rajwani KM, Lavrador JP, Oviedova A, Gullan R, Ashkan K, Vergani F, Bhangoo R. Intraoperative ultrasound to aid resection of a peritorcular meningioma: a technical note. J Surg Case Rep 2021; 2021:rjab462. [PMID: 34733473 PMCID: PMC8560207 DOI: 10.1093/jscr/rjab462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 09/21/2021] [Indexed: 11/17/2022] Open
Abstract
Surgery for meningiomas involving dural venous sinuses is challenging. We describe a case of a peritorcular meningioma involving major venous sinuses, which was removed using a venous sparing approach with the aid of intraoperative ultrasound. We found ultrasound to be a useful adjunct as it enabled us to get real-time information about the location of venous structures, their function and demonstrate dynamic changes in blood flow during surgery.
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Affiliation(s)
| | | | - Anna Oviedova
- Department of Neurosurgery, King's College Hospital, London, UK
| | - Richard Gullan
- Department of Neurosurgery, King's College Hospital, London, UK
| | | | | | - Ranjeev Bhangoo
- Department of Neurosurgery, King's College Hospital, London, UK
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12
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Carai A, De Benedictis A, Calloni T, Onorini N, Paternò G, Randi F, Colafati GS, Mastronuzzi A, Marras CE. Intraoperative Ultrasound-Assisted Extent of Resection Assessment in Pediatric Neurosurgical Oncology. Front Oncol 2021; 11:660805. [PMID: 33968768 PMCID: PMC8097032 DOI: 10.3389/fonc.2021.660805] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 03/16/2021] [Indexed: 11/24/2022] Open
Abstract
Central nervous system tumors represent the most frequent solid malignancy in the pediatric population. Maximal safe surgical resection is a mainstay of treatment, with significant prognostic impact for the majority of histotypes. Intraoperative ultrasound (ioUS) is a widely available tool in neurosurgery to assist in intracerebral disease resection. Despite technical caveats, preliminary experiences suggest a satisfactory predictive ability, when compared to magnetic resonance imaging (MRI) studies. Most of the available evidence on ioUS applications in brain tumors derive from adult series, a scenario that might not be representative of the pediatric population. We present our preliminary experience comparing ioUS-assisted resection assessment to early post-operative MRI findings in 154 consecutive brain tumor resections at our pediatric neurosurgical unit. A high concordance was observed between ioUS and post-operative MRI. Overall ioUS demonstrated a positive predictive value of 98%, a negative predictive value of 92% in assessing the presence of tumor residue compared to postoperative MRI. Overall, sensibility and specificity were 86% and 99%, respectively. On a multivariate analysis, the only variable significantly associated to unexpected tumor residue on postoperative MRI was histology. Tumor location, patient positioning during surgery, age and initial tumor volume were not significantly associated with ioUS predictive ability. Our data suggest a very good predictive value of ioUS in brain tumor resective procedures in children. Low-grade glioma, high-grade glioma and craniopharyngioma might represent a setting deserving specific endeavours in order to improve intraoperative extent of resection assessment ability.
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Affiliation(s)
- Andrea Carai
- Neurosurgery Unit, Department of Neurological and Psychiatric Sciences, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - Alessandro De Benedictis
- Neurosurgery Unit, Department of Neurological and Psychiatric Sciences, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - Tommaso Calloni
- School of Neurosurgery, University of Milan-Bicocca, Milan, Italy
| | - Nicola Onorini
- Neurosurgery Unit, Department of Neurological and Psychiatric Sciences, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - Giovanni Paternò
- Neurosurgery Unit, Department of Neurological and Psychiatric Sciences, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - Franco Randi
- Neurosurgery Unit, Department of Neurological and Psychiatric Sciences, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | | | - Angela Mastronuzzi
- Department of Hematology/Oncology, Cell and Gene Therapy, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - Carlo Efisio Marras
- Neurosurgery Unit, Department of Neurological and Psychiatric Sciences, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
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13
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Šteňo A, Buvala J, Šteňo J. Large Residual Pilocytic Astrocytoma After Failed Ultrasound-Guided Resection: Intraoperative Ultrasound Limitations Require Special Attention. World Neurosurg 2021; 150:140-143. [PMID: 33819702 DOI: 10.1016/j.wneu.2021.03.138] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 03/25/2021] [Accepted: 03/26/2021] [Indexed: 11/28/2022]
Abstract
While benefits of neurosurgical intraoperative ultrasound (IOUS) are reported frequently, this method still has some significant pitfalls, which are described less often. However, sufficient knowledge on dealing with IOUS drawbacks, particularly various image artifacts, is important for successful surgery. We report a case of failed IOUS-guided pediatric cerebellar pilocytic astrocytoma resection, incorrectly evaluated as gross total resection according to IOUS. A large tumor residuum was left in place. Successful IOUS-guided reoperation using new IOUS technology and appropriate ultrasound imaging technique are described. The most probable reasons for initial resection failure and crucial points of reoperation, predominantly dealing with IOUS artifacts, are discussed. Neurosurgeons should be aware of IOUS limitations and have sufficient knowledge about how to overcome them before adopting routine use of this intraoperative imaging modality.
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Affiliation(s)
- Andrej Šteňo
- Department of Neurosurgery, Comenius University, Faculty of Medicine, University Hospital Bratislava, Bratislava, Slovakia.
| | - Ján Buvala
- Department of Neurosurgery, Comenius University, Faculty of Medicine, University Hospital Bratislava, Bratislava, Slovakia
| | - Juraj Šteňo
- Department of Neurosurgery, Comenius University, Faculty of Medicine, University Hospital Bratislava, Bratislava, Slovakia
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14
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Functional brain mapping: overview of techniques and their application to neurosurgery. Neurosurg Rev 2018; 42:639-647. [DOI: 10.1007/s10143-018-1007-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 06/25/2018] [Accepted: 07/06/2018] [Indexed: 10/28/2022]
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15
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Non-surgical transient cerebellar mutism-case report and systematic review. Childs Nerv Syst 2018; 34:535-540. [PMID: 29067507 DOI: 10.1007/s00381-017-3643-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 10/17/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Transient cerebellar mutism has been well recognized in literature as a complication of posterior fossa tumor resection. It is marked by profound impairment of fluency, articulation, and modulation of speech, irritability and autistic features and typically resolves within days to months. Underlying pathophysiology is debated, but currently unknown. METHODS We present a case of a child with similar clinical findings after cerebellitis, demonstration of diffuse cerebellar signal changes, swelling, and protruding tonsils at the level of foramen magnum. DISCUSSION To support the hypothesis that this clinical syndrome may occur in a non-surgical context, we present a review of literature of non-surgical transient cerebellar mutism.
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16
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Bayer S, Maier A, Ostermeier M, Fahrig R. Intraoperative Imaging Modalities and Compensation for Brain Shift in Tumor Resection Surgery. Int J Biomed Imaging 2017; 2017:6028645. [PMID: 28676821 PMCID: PMC5476838 DOI: 10.1155/2017/6028645] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Accepted: 05/03/2017] [Indexed: 11/26/2022] Open
Abstract
Intraoperative brain shift during neurosurgical procedures is a well-known phenomenon caused by gravity, tissue manipulation, tumor size, loss of cerebrospinal fluid (CSF), and use of medication. For the use of image-guided systems, this phenomenon greatly affects the accuracy of the guidance. During the last several decades, researchers have investigated how to overcome this problem. The purpose of this paper is to present a review of publications concerning different aspects of intraoperative brain shift especially in a tumor resection surgery such as intraoperative imaging systems, quantification, measurement, modeling, and registration techniques. Clinical experience of using intraoperative imaging modalities, details about registration, and modeling methods in connection with brain shift in tumor resection surgery are the focuses of this review. In total, 126 papers regarding this topic are analyzed in a comprehensive summary and are categorized according to fourteen criteria. The result of the categorization is presented in an interactive web tool. The consequences from the categorization and trends in the future are discussed at the end of this work.
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Affiliation(s)
- Siming Bayer
- Pattern Recognition Lab, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Erlangen, Germany
| | - Andreas Maier
- Pattern Recognition Lab, Friedrich-Alexander-University Erlangen-Nuremberg (FAU), Erlangen, Germany
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17
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Moiyadi AV, Shetty P, Degaonkar A. Resection of Pediatric Brain Tumors: Intraoperative Ultrasound Revisited. J Pediatr Neurosci 2017; 12:19-23. [PMID: 28553373 PMCID: PMC5437781 DOI: 10.4103/jpn.jpn_141_16] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background: Extent of resection is a very important prognostic marker in most pediatric brain tumors. Intraoperative imaging facilitates resection control. Intraoperative ultrasound (IOUS) is a cost-effective alternative to intraoperative magnetic resonance, but scant literature addresses its utility in this context. Methods: We retrospectively reviewed all pediatric brain tumors operated at our center using navigated three-dimensional ultrasound (US). The utility of the US in resection control was recorded and extent of resection evaluated. Results: IOUS was used in 20 cases (3 for frameless biopsy and 17 for tumor resection control). It was 100% accurate in localizing all tumors and yielded 100% diagnosis in the biopsy cases. Technical limitations precluded its use in 2 of the 17 cases of tumor resection. In the remaining 15, it correctly predicted the residual tumor status in 13 cases (87%). A gross total resection was achieved overall in 12 cases (80%) with postoperative morbidity in only one case. Conclusions: IOUS is a useful tool to localize intracranial tumors and guide the resection reliably. Widespread use can improve its applicability and make it an effective intraoperative imaging tool in pediatric brain tumors.
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Affiliation(s)
- Aliasgar V Moiyadi
- Department of Surgical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Prakash Shetty
- Department of Surgical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Amol Degaonkar
- Department of Surgical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
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18
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Zebian B, Vergani F, Lavrador JP, Mukherjee S, Kitchen WJ, Stagno V, Chamilos C, Pettorini B, Mallucci C. Recent technological advances in pediatric brain tumor surgery. CNS Oncol 2016; 6:71-82. [PMID: 28001090 DOI: 10.2217/cns-2016-0022] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
X-rays and ventriculograms were the first imaging modalities used to localize intracranial lesions including brain tumors as far back as the 1880s. Subsequent advances in preoperative radiological localization included computed tomography (CT; 1971) and MRI (1977). Since then, other imaging modalities have been developed for clinical application although none as pivotal as CT and MRI. Intraoperative technological advances include the microscope, which has allowed precise surgery under magnification and improved lighting, and the endoscope, which has improved the treatment of hydrocephalus and allowed biopsy and complete resection of intraventricular, pituitary and pineal region tumors through a minimally invasive approach. Neuronavigation, intraoperative MRI, CT and ultrasound have increased the ability of the neurosurgeon to perform safe and maximal tumor resection. This may be facilitated by the use of fluorescing agents, which help define the tumor margin, and intraoperative neurophysiological monitoring, which helps identify and protect eloquent brain.
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Affiliation(s)
- Bassel Zebian
- Department of Pediatric Neurosurgery, Alder Hey Children's NHS Foundation Trust, Eaton Road, Liverpool L12 2AP, UK.,Department of Pediatric & Adult Neurosurgery, King's College Hospital NHS Foundation Trust, Denmark Hill, London SE5 9RS, UK
| | - Francesco Vergani
- Department of Pediatric & Adult Neurosurgery, King's College Hospital NHS Foundation Trust, Denmark Hill, London SE5 9RS, UK
| | - José Pedro Lavrador
- Department of Pediatric & Adult Neurosurgery, King's College Hospital NHS Foundation Trust, Denmark Hill, London SE5 9RS, UK
| | - Soumya Mukherjee
- Department of Neurosurgery, Leeds General Infirmary, Leeds LS1 3EX, UK
| | - William John Kitchen
- Department of Pediatric Neurosurgery, Alder Hey Children's NHS Foundation Trust, Eaton Road, Liverpool L12 2AP, UK
| | - Vita Stagno
- Department of Pediatric Neurosurgery, Alder Hey Children's NHS Foundation Trust, Eaton Road, Liverpool L12 2AP, UK
| | - Christos Chamilos
- Department of Pediatric Neurosurgery, Alder Hey Children's NHS Foundation Trust, Eaton Road, Liverpool L12 2AP, UK
| | - Benedetta Pettorini
- Department of Pediatric Neurosurgery, Alder Hey Children's NHS Foundation Trust, Eaton Road, Liverpool L12 2AP, UK
| | - Conor Mallucci
- Department of Pediatric Neurosurgery, Alder Hey Children's NHS Foundation Trust, Eaton Road, Liverpool L12 2AP, UK
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Consensus paper on post-operative pediatric cerebellar mutism syndrome: the Iceland Delphi results. Childs Nerv Syst 2016; 32:1195-203. [PMID: 27142103 DOI: 10.1007/s00381-016-3093-3] [Citation(s) in RCA: 129] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 04/13/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Confusion has surrounded the description of post-operative mutism and associated morbidity in pediatric patients with cerebellar tumors for years. The heterogeneity of definitions and diagnostic features has hampered research progress within the field, and to date, no international guidelines exist on diagnosis, prevention, treatment, or follow-up of this debilitating condition. An international group of clinicians and researchers from multiple relevant disciplines recently formed a cohesive panel to formulate a new working definition and agree upon standardized methods for diagnosis and follow-up. METHODS Consensus was obtained using the modified nominal group technique, involving four rounds of online Delphi questionnaires interspersed with a structured consensus conference with lectures, group work, and open discussion sessions. RESULTS A new, proposed definition of "post-operative pediatric CMS" was formed, preliminary recommendations for diagnostic and follow-up procedures were created, two working groups on a new scoring scale and risk prediction and prevention were established, and areas were identified where further information is needed. DISCUSSION The consensus process was motivated by desire to further research and improve quality of life for pediatric brain tumor patients. The Delphi rounds identified relevant topics and established basic agreement, while face-to-face engagement helped resolve matters of conflict and refine terminology. The new definition is intended to provide a more solid foundation for future clinical and research work. It is thought as a consensus for moving forward and hopefully paves the way to developing a standard approach to this challenging problem with the advent of better scoring methods and ultimate goal of reducing the risk of CMS.
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20
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Abstract
INTRODUCTION Cerebellar mutism (CM) is defined as a peculiar form of mutism that may complicate the surgical excision of posterior cranial fossa tumor. The incidence is variable in the literature, occurring in up to one third of cases in some series. Commonly occurring peculiar features of CM are delayed onset following surgery, limited duration, and spontaneous recovery usually associated with dysarthria. METHODS A review has been performed concerning anatomical substrates and circuits actually considered to be involved in the development of cerebellar mutism, as well as risk factors for its development that have been documented in the literature. Attention has also been given to the long-term prognosis and the possibilities of rehabilitation that can be considered in these children, which has been compared with the authors' institutional experience. RESULTS AND CONCLUSIONS Tumor infiltration of the brainstem seems to represent the most relevant feature related to the development of CM, along with the histological diagnosis of medulloblastoma. On the other hand, hydrocephalus does not represent an independent risk factor. The higher rate of CM in children seems to be related to the higher incidence in children of tumors with malignant histology and brain stem involvement. Surgical technique does not seem to have a definite role; in particular, the use of a telovelar approach as compared to vermian split to reach the fourth ventricle extension of the tumor has not been demonstrated to prevent the development of cerebellar mutism. Concerning long-term prognosis, around one third of the children who develop cerebellar mutism after surgery have a persistent dysarthria, the remaining ones showing a residual phonological impairment. Long-term dysarthric features tend to be more severe and less prone to recovery in children presenting at diagnosis with associated combined procedural memory and defective neurocognitive functions.
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21
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Burkhardt JK, Serra C, Neidert MC, Woernle CM, Fierstra J, Regli L, Bozinov O. High-frequency intra-operative ultrasound-guided surgery of superficial intra-cerebral lesions via a single-burr-hole approach. ULTRASOUND IN MEDICINE & BIOLOGY 2014; 40:1469-1475. [PMID: 24680295 DOI: 10.1016/j.ultrasmedbio.2014.01.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Revised: 01/24/2014] [Accepted: 01/29/2014] [Indexed: 06/03/2023]
Abstract
The study described here examined the feasibility of using high-frequency intra-operative ultrasound (hfioUS) guidance to resect superficial intra-cerebral lesions through a single burr hole. A cohort of 23 consecutive patients with a total of 24 intra-cerebral lesions (9 intra-cerebral metastases, 8 gliomas, 4 infections, 2 lymphomas and 1 cavernoma) were studied. All lesions could be localized and successfully resected, biopsied or aspirated, and histopathological diagnoses were obtained in all cases. The mean operating time was 59.6 ± 23.9 min. The mean cross-sectional lesion size was 6.4 ± 7.6 cm(2), and the mean cortex surface-to-lesion distance was 0.6 ± 0.8 cm. Our results illustrate the feasibility of identifying and resecting superficial intra-cerebral lesions under hfioUS guidance via a single-burr-hole approach. We were able to achieve short resection times with no post-operative complications in all patients, favorable conditions under which to start adjuvant therapy when indicated.
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Affiliation(s)
- Jan-Karl Burkhardt
- Department of Neurosurgery, University Hospital of Zurich, Zurich, Switzerland.
| | - Carlo Serra
- Department of Neurosurgery, University Hospital of Zurich, Zurich, Switzerland
| | - Marian C Neidert
- Department of Neurosurgery, University Hospital of Zurich, Zurich, Switzerland
| | - Christoph M Woernle
- Department of Neurosurgery, University Hospital of Zurich, Zurich, Switzerland
| | - Jorn Fierstra
- Department of Neurosurgery, University Hospital of Zurich, Zurich, Switzerland
| | - Luca Regli
- Department of Neurosurgery, University Hospital of Zurich, Zurich, Switzerland
| | - Oliver Bozinov
- Department of Neurosurgery, University Hospital of Zurich, Zurich, Switzerland
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22
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Surgical and clinical aspects of cerebellar pilomyxoid-spectrum astrocytomas in children. Childs Nerv Syst 2014; 30:1045-53. [PMID: 24497195 DOI: 10.1007/s00381-014-2366-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Accepted: 01/14/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Cerebellar pilomyxoid astrocytomas (PMAs) and intermediate pilomyxoid astrocytomas (IPAs) are collectively called "pilomyxoid-spectrum astrocytomas (PMSAs)." Cerebellar PMSAs are thought to behave more aggressively than pilocytic astrocytomas (PAs). Our objective is to compare PMSAs to PAs in terms of surgical and clinical profiles. METHODS This retrospective study included 66 cases (35 males and 31 females) with cerebellar astrocytomas treated between July 2007 and December 2012 at Children's Cancer Hospital Egypt (CCHE 57357) with a mean age of 7 (±1.5) years. Cases were divided into three subgroups as follows: 44 PAs, 10 IPAs, and 12 PMAs. Comparison between all groups was focusing on brain stem invasion, intrinsic necrotic cavitation, extent of resection, recurrence, leptomeningeal dissemination (LD), metastases, need for CSF diversion, and cerebellar mutism (CM). RESULTS Cerebellar PMAs and IPAs separately and collectively had higher incidence of brain stem invasion, intrinsic necrotic cavitation, tumor recurrence, and LD when compared to PAs (P < 0.001). Gross total resection was 13.6 % in PMSAs versus 90.9 % in PAs (P < 0.001). PMAs had a higher incidence of tumor recurrence than IPAs (66.7 versus 20 %, P < 0.001). Incidence of recurrence in PAs was 9.1 % in partially resected cases. Mean interval to recurrence was 9 (±1.5) months in PMSAs and 42 (±2) months in PAs. CONCLUSIONS Cerebellar PMSAs express an aggressive clinical behavior and impose more operative challenges than PAs. These tumors may represent a clinical spectrum-at its benign end lies PA, while PMA lies at the aggressive end, with IPA lying just behind. Such concepts could be used to guide management in the future.
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23
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Reed-Berendt R, Phillips B, Picton S, Chumas P, Warren D, Livingston JH, Hughes E, Morrall MCHJ. Cause and outcome of cerebellar mutism: evidence from a systematic review. Childs Nerv Syst 2014; 30:375-85. [PMID: 24452481 DOI: 10.1007/s00381-014-2356-0] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2013] [Accepted: 01/02/2014] [Indexed: 11/26/2022]
Abstract
PURPOSE Cerebellar mutism is a serious neurosurgical complication after posterior fossa surgery, but the cause, incidence and outcome remain incompletely defined. The aim of this paper was to identify and review all reports of this phenomenon to better delineate and improve the evidence base. METHODS A systematic search and retrieval of databases was conducted using advanced search techniques. Review/outcomes criteria were developed, and study quality was determined. RESULTS The retrieval identified 2,281 papers of which 96 were relevant, identifying 650 children with cerebellar mutism. Causative factors, clinical features and outcomes were reported variably; papers focussed on multiple areas, the majority reporting incidence in single or series of case studies with little or no analysis further than description. CONCLUSIONS The complexity and variability of data reporting, likely contributing factors and outcomes make cerebellar mutism difficult to predict in incidence and the degree of impact that may ensue. A clear and accepted universal definition would help improve reporting, as would the application of agreed outcome measures. Clear and consistent reporting of surgical technique remains absent. Recommendations for practice are provided.
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Affiliation(s)
- Rosa Reed-Berendt
- Paediatric Neuropsychology, The Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Great George Street, Leeds, LS1 3EX, UK
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24
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Abstract
Mutism of cerebellar origin is a well-described clinical entity that complicates operations for posterior fossa tumors, especially in children. This review focuses on the current understanding of principal pathophysiological aspects and risk factors, epidemiology, clinical characteristics, treatment strategies, and outcome considerations. The PubMed database was searched using the term cerebellar mutism and relevant definitions to identify publications in the English-language literature. Pertinent publications were selected from the reference lists of the previously identified articles. Over the last few years an increasing number of prospective studies and reviews have provided valuable information regarding the cerebellar mutism syndrome. Importantly, the clarification of principal terminology that surrounds the wide clinical spectrum of the syndrome results in more focused research and more effective identification of this entity. In children who undergo surgery for medulloblastoma the incidence of cerebellar mutism syndrome was reported to be 24%, and significant risk factors so far are brainstem involvement and midline location of the tumor. The dentate-thalamo-cortical tracts and lesions that affect their integrity are considered significant pathophysiological issues, especially the tract that originates in the right cerebellar hemisphere. Moderate and severe forms of the cerebellar mutism syndrome are the most frequent types during the initial presentation, and the overall neurocognitive outcome is not as favorable as thought in the earlier publications. Advanced neuroimaging techniques could contribute to identification of high-risk patients preoperatively and allow for more effective surgical planning that should focus on maximal tumor resection with minimal risk to important neural structures. Properly designed multicenter trials are needed to provide stronger evidence regarding effective prevention of cerebellar mutism and the best therapeutic approaches for such patients with a combination of pharmacological agents and multidisciplinary speech and behavior augmentation.
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Affiliation(s)
- Marina Pitsika
- Department of Pediatric Neurosurgery, Mitera Children's Hospital, Athens, Greece
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