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Cinalli MA, Malineni S, Spennato P, Nayak SS, Cinalli G, Deopujari C. Neuroendoscopy: intraventricular and skull base tumor resection in children. Childs Nerv Syst 2023; 39:2737-2756. [PMID: 37589762 DOI: 10.1007/s00381-023-06110-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 07/28/2023] [Indexed: 08/18/2023]
Abstract
During the last 30 years, the neurosurgeons have witnessed a revolution in the practice of interventricular surgery. The advent of neuroendoscopy at the end of the 1980s has allowed a minimally invasive management of a very large series of pathologies in pediatric neurosurgery ranging from hydrocephalus to arachnoid cyst to intraventricular tumors. The progresses in the management of hydrocephalus, intracranial cyst, and the fluid filled collection nevertheless has been more rapid and radical due to the simpler equipment that is necessary to perform this kind of surgery. The intraventricular tumors instead have been addressed in a slower way, and for many years, the only endoscopic procedure that was allowed on interventricular tumors was a biopsy associated with the management of hydrocephalus. Only very small tumors have been considered operable for complete removal during many years due to the limitations of the neuroendoscopic equipment and to the small calibers of the working channel. More recently, the advent of new devices and new surgical techniques are offering new perspectives on the possibility of intraventricular tumor surgery in children. In this review, we describe the historical perspective of the learning curve of intraventricular tumor surgery under neuroendoscopic control and try to offer a view of the future perspective in the removal of larger intraventricular tumors, analyzing the main indications for intraventricular endoscopic tumor surgery. We offer as well an historical perspective of the evolution of skull base surgery and endonasal transsphenoidal approach for skull-based tumors in children. This kind of surgery that has acquired widespread acceptance for many pathologies in adult age has diffused more slowly in pediatric neurosurgery due to the anatomical limitation observed in these age range. Also in this field, the slow evolution of the technique and of the technology available to neurosurgeons has allowed a very significant expansion of indication for the minimally invasive removal of skull base tumors in children.
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Affiliation(s)
| | - Suhas Malineni
- Department of Neurosurgery, Bombay Hospital, Mumbai, India
| | - Pietro Spennato
- Pediatric Neurosurgery Unit, Department of Pediatric Neurosciences, Santobono-Pausilipon Children's Hospital (AORN), Via Mario Fiore N. 6, 80129, Naples, Italy
| | | | - Giuseppe Cinalli
- Pediatric Neurosurgery Unit, Department of Pediatric Neurosciences, Santobono-Pausilipon Children's Hospital (AORN), Via Mario Fiore N. 6, 80129, Naples, Italy.
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Tomita T, Alden TD, Dipatri AJ. Pediatric pineal region tumors: institutional experience of surgical managements with posterior interhemispheric transtentorial approach. Childs Nerv Syst 2023; 39:2293-2305. [PMID: 35821434 PMCID: PMC10432319 DOI: 10.1007/s00381-022-05595-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 06/23/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE Resecting pineal region tumors in children is often challenging. Several approaches have been proposed and practiced. A personal series of pediatric pineal region tumors resected through craniotomy with posterior interhemispheric occipital transtentorial (OT) approach are reviewed. We present the surgical techniques, pitfalls, and their results. MATERIAL AND METHODS Eighty patients ranging in age from 3 months to 21 years old, and treated over 3 decades were reviewed. Hydrocephalus caused the main presenting symptoms and was noted in 74 patients. It was treated prior to the craniotomy for tumor resection with endoscopic third ventriculostomy (ETV) in 33, external ventricular drainage in 26, and precraniotomy shunt in 15. Nine patients had ETV together with endoscopic biopsy. All patients had a parieto-occipital craniotomy in a prone position. Through a tentorial section, a gross total resection of the tumor was attempted except for germinomas. RESULTS The tumor pathology showed 32 germ cell tumors (GCT), 22 benign astrocytomas, 13 pineal parenchymal tumors, 5 ATRTs, 3 papillary tumors, and 5 others. Of GCTs, 18 were teratomas. The extent of resection consisted of 55 gross total resections, 13 subtotal resections, 10 partial, and 2 biopsies with one postoperative death. Hemiparesis in 2, cerebellar ataxia in another 2, and hemiballismus in 1 were transient and improved over time. One had permanent hemisensory loss and another patient had bilateral oculomotor palsy. Postoperative homonymous hemianopia occurred in 2 patients but subsided over a short period of time. Parinaud's sign was noted in 24 patients, of which 16 were transient. CONCLUSION The posterior interhemispheric OT approach provides a safe route and comfortable access to the pineal region in children. A great majority of postoperative neurological complications are the results of direct manipulations of the midbrain at tumor resection. Identification and preservation of the tumor-brain interface are of paramount importance. GCTs other than teratomas are treated with neoadjuvant chemotherapy and may eliminate the need for craniotomy. Exophytic midbrain JPAs are amenable to resection.
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Affiliation(s)
- Tadanori Tomita
- Department of Neurological Surgery, Division of Pediatric Neurosurgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - Tord D Alden
- Department of Neurological Surgery, Division of Pediatric Neurosurgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Arthur J Dipatri
- Department of Neurological Surgery, Division of Pediatric Neurosurgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Deopujari C, Shroff K, Karmarkar V, Mohanty C. Neuroendoscopy in the management of pineal region tumours in children. Childs Nerv Syst 2023; 39:2353-2365. [PMID: 35665837 DOI: 10.1007/s00381-022-05561-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 05/24/2022] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Pineal region tumours (PRTs) are more common in children and represent a wide variety of lesions. The practise of a radiation test dose is obsolete and a biochemical/histological diagnosis is recommended before further therapy. Many patients present with hydrocephalus. Advances in neuroendoscopic techniques have allowed safe and effective management of this obstructive hydrocephalus with an opportunity to sample cerebrospinal fluid (CSF) and obtain tissue for histopathology. Definitive surgery is required in less than a third. Endoscopic visualisation and assistance is increasingly used for radical resection, where indicated. METHODOLOGY Our experience of endoscopic surgery for paediatric PRTs from 2002 to 2021 is presented. All patients underwent MRI with contrast. Serum tumour markers were checked. If negative, endoscopic biopsy and endoscopic third ventriculostomy (ETV) were performed; and CSF collected for tumour markers and abnormal cells. For radical surgery, endoscope-assisted microsurgery procedures were performed to minimise retraction, visualise the extent of resection and confirm haemostasis. RESULTS M:F ratio was 2:1. The median age of presentation was 11 years. Raised ICP (88.88%) was the commonest mode of presentation. Nineteen patients had pineal tumours, one had a suprasellar and pineal tumour, one had disseminated disease, while six had tectal tumours. The ETB diagnosis rate was 95.45%, accuracy rate was 83.3% and ETV success rate was 86.96%. CONCLUSION Neuroendoscopy has revolutionised the management of paediatric PRTs. It is a safe and effective procedure with good diagnostic yield and allows successful concurrent CSF diversion, thereby avoiding major surgeries and shunt implantation. It is also helpful in radical resection of lesions, where indicated.
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Affiliation(s)
- Chandrashekhar Deopujari
- Department of Neurosurgery, Bombay Hospital Institute of Medical Sciences, New Marine Lines, Mumbai, Maharashtra, India, 400020.
| | - Krishna Shroff
- Department of Neurosurgery, Bombay Hospital Institute of Medical Sciences, New Marine Lines, Mumbai, Maharashtra, India, 400020
| | - Vikram Karmarkar
- Department of Neurosurgery, Bombay Hospital Institute of Medical Sciences, New Marine Lines, Mumbai, Maharashtra, India, 400020
| | - Chandan Mohanty
- Department of Neurosurgery, Bombay Hospital Institute of Medical Sciences, New Marine Lines, Mumbai, Maharashtra, India, 400020
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Fan Y, Huo X, Li X, Wang L, Wu Z. Non-invasive preoperative imaging differential diagnosis of pineal region tumor: A novel developed and validated multiparametric MRI-based clinicoradiomic model. Radiother Oncol 2022; 167:277-284. [PMID: 35033600 DOI: 10.1016/j.radonc.2022.01.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 12/26/2021] [Accepted: 01/05/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND Preoperative differential diagnosis of pineal region tumor can greatly assist clinical decision-making and avoid economic costs and complications caused by unnecessary radiotherapy or invasive procedures. The present study was performed to pre-operatively distinguish pineal region germinoma and pinealoblastoma using a clinicoradiomic model by incorporating radiomic and clinical features. METHODS 134 pineal region tumor patients (germinoma, 69; pinealoblastoma, 65) with complete clinic-radiological and histopathological data from Tiantan hospital were retrospectively reviewed and randomly assigned to training and validation sets. Radiomic features were extracted from MR images, then the elastic net and recursive feature elimination algorithms were applied to select radiomic features for constructing a fusion radiomic model. Subsequently, multivariable logistic regression analysis was used to select the clinical features, and a clinicoradiomic model incorporating the fusion radiomic model and selected clinical features was constructed for individual predictions. The calibration, discriminating capacity, and clinical usefulness were also evaluated. RESULTS Seven significant radiomic features were selected to construct a fusion radiomic model that achieved an area under the curve (AUC) value of 0.920 and 0.880 in the training and validation sets, respectively. A clinicoradiomic model that incorporated the radiomic model and four selected clinical features was constructed and showed good discrimination and calibration, with an AUC of 0.950 in the training set and 0.940 in the validation set. The analysis of the decision curve showed that the radiomic model and clinicoradiomic model were clinically useful for patients with pineal region tumor. CONCLUSIONS Our clinicoradiomic model showed great performance and high sensitivity in the differential diagnosis of germinoma and pinealoblastoma, and could contribute to non-invasive development of individualized diagnosis and treatment of patients with pineal region tumor.
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Affiliation(s)
- Yanghua Fan
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Xulei Huo
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Xiaojie Li
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Liang Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China.
| | - Zhen Wu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China.
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Mathkour M, Hanna J, Ibrahim N, Scullen T, Kilgore MD, Werner C, Cormier I, Spencer P, Keen JR, Bui CJ. Papillary tumor of the pineal region in pediatric populations: An additional case and systematic review of a rare tumor entity. Clin Neurol Neurosurg 2020; 201:106404. [PMID: 33360024 DOI: 10.1016/j.clineuro.2020.106404] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 11/23/2020] [Accepted: 11/24/2020] [Indexed: 10/22/2022]
Abstract
Papillary tumors of the pineal region (PTPR) are a rare tumor entity first described in 2003, later codified in the 2007 WHO tumor classification system. PTPRs most commonly occur in the third and fourth decades, with exceedingly rare presentations in pediatric populations. Herein, we present an additional case of a 10-year-old female found to have PTPR in conjunction with Trisomy 21 managed successfully with cerebrospinal fluid diversion and gross total resection (GTR). Three years after resection she has returned to baseline without recurrence. We also performed a comprehensive review of the current literature discussing the diagnosis, treatment, and pathophysiologic correlations in children. Diagnosis and management of PTPRs is a topic that is increasingly garnering attention in the literature given the recent characterization of this tumor entity. However, relatively little is known about the presentation of PTPRs in pediatric populations. In adults, PTPRs have been linked with several chromosomal and genetic abnormalities; however this correlation is limited in pediatric literature. Although GTR is the mainstay for treatment, the application of adult treatment protocols may not be advisable due to age and the developmental changes of the CNS in children.
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Affiliation(s)
- Mansour Mathkour
- Ochsner Health System, Department of Neurosurgery, New Orleans, LA, USA; Tulane Medical Center, Department of Neurosurgery, New Orleans, LA, USA; Neurosurgery Division, Surgery Department, Jazan University, Jazan, Saudi Arabia.
| | - Joshua Hanna
- Ochsner Health System, Department of Neurosurgery, New Orleans, LA, USA; Tulane Medical Center, Department of Neurosurgery, New Orleans, LA, USA.
| | - Naser Ibrahim
- Ochsner Health System, Department of Neurosurgery, New Orleans, LA, USA; Tulane Medical Center, Department of Neurosurgery, New Orleans, LA, USA.
| | - Tyler Scullen
- Ochsner Health System, Department of Neurosurgery, New Orleans, LA, USA; Tulane Medical Center, Department of Neurosurgery, New Orleans, LA, USA.
| | - Mitchell D Kilgore
- Tulane Medical Center, Department of Neurosurgery, New Orleans, LA, USA.
| | - Cassidy Werner
- Tulane Medical Center, Department of Neurosurgery, New Orleans, LA, USA.
| | - Ian Cormier
- Ochsner Health System, Department of Neurosurgery, New Orleans, LA, USA; Tulane Medical Center, Department of Neurosurgery, New Orleans, LA, USA.
| | - Pierce Spencer
- Tulane Medical Center, Department of Neurosurgery, New Orleans, LA, USA.
| | - Joseph R Keen
- Ochsner Health System, Department of Neurosurgery, New Orleans, LA, USA; Tulane Medical Center, Department of Neurosurgery, New Orleans, LA, USA.
| | - Cuong J Bui
- Ochsner Health System, Department of Neurosurgery, New Orleans, LA, USA; Tulane Medical Center, Department of Neurosurgery, New Orleans, LA, USA.
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Management of mature pineal region teratomas in pediatric age group. Childs Nerv Syst 2020; 36:153-163. [PMID: 31144023 DOI: 10.1007/s00381-019-04204-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 05/09/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE Mature pineal region teratomas differ from other pineal tumors in terms of their characteristic radiological appearance and their clinical outcome after gross total excision. Our aim is to share our clinical experience and treatment outcomes in pediatric patients with mature pineal region teratoma. METHODS In this retrospective study, we reviewed clinical, radiological, and surgical data of ten patients who had radiologically predicted diagnosis of pineal region teratoma and pathologically confirmed diagnosis of mature pineal region teratoma between years 2004 and 2017 in our clinic. Statistical analysis was performed with SPSS 20. RESULTS All patients were male. Ages of patients ranged between 5 and 17 (median age was 9.5). All of them presented with headache. Magnetic resonance imaging showed characteristic appearance of teratomas with variable degree of hydrocephalus. All patients had negative results for AFP and b-HCG levels. All patients had gross total resection of pineal tumor through occipital transtentorial approach with no permanent neurological deficit. Pathological results of all tumor samples were consistent with mature teratoma. None of them had adjuvant chemotherapy or radiotherapy. Follow-up periods ranged between 3 and 170 months (median follow-up period was 60.5 months). All patients are alive with no tumor recurrence. CONCLUSIONS Pediatric mature pineal region teratomas are benign tumors with characteristic MRI appearance and negative tumor markers. Their definitive treatment is gross total surgical excision. Occipital transtentorial approach is a safe procedure for treatment of pediatric mature pineal teratomas.
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Samadian M, Maloumeh EN, Shiravand S, Ebrahimzadeh K, Sharifi G, Mousavinejad A, Rezaei O. Pineal region tumors: Long-term results of endoscopic third ventriculostomy and concurrent tumor biopsy with a single entry approach in a series of 64 cases. Clin Neurol Neurosurg 2019; 184:105418. [PMID: 31319237 DOI: 10.1016/j.clineuro.2019.105418] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 07/04/2019] [Accepted: 07/06/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Endoscopic third ventriculostomy and concurrent biopsy is increasingly used in management of the pineal region tumors. Our objective was to assess the results of single entry approach to surgically manage the tumors of the pineal region. PATIENTS AND METHODS A retrospective study was designed, and a series of 64 consecutive patients (31 male, 33 female) with pineal region tumor undergoing endoscopic third ventriculostomy and concurrent biopsy of the tumor was undertaken. RESULTS A total of 64 patients underwent simultaneous endoscopic third ventriculostomy and biopsy of the pineal tumors with a single entry approach. A positive initial diagnosis was established in 97% of patients. 5 patients (7%) required the insertion of an external ventricular drain which was removed in all patients after 72 h but in one case (1%) undergoing permanent VP shunt insertion. The postoperative complications were divided into two transient and permanent complications. The transient complications included intraventricular hemorrhage (18%), seizure (1 to two episodes of seizure) (5%), diabetes insipidus (3%) and meningitis (3%) all were successfully managed. The only permanent complication was memory deficits occurred in one patient (1%). There was no mortality rate in current study. CONCLUSION The results of this study support the safety and efficacy of endoscopic third ventriculostomy and concurrent biopsy of the pineal region tumors as a less invasive surgical method associated with low morbidity and mortality rate. Our data demonstrated how simultaneous endoscopic third ventriculostomy and biopsy of the pineal region tumors with a single entry approach can produce favorable results.
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Affiliation(s)
- Mohammad Samadian
- Skull Base Research Center, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Ehsan Nazari Maloumeh
- Skull Base Research Center, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Sepideh Shiravand
- Skull Base Research Center, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Kaveh Ebrahimzadeh
- Skull Base Research Center, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Guive Sharifi
- Skull Base Research Center, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Ali Mousavinejad
- Skull Base Research Center, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Omidvar Rezaei
- Skull Base Research Center, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Hleyhel M, Goujon S, Sibiude J, Tubiana R, Dollfus C, Faye A, Mandelbrot L, Clavel J, Warszawski J, Blanche S. Risk of cancer in children exposed to antiretroviral nucleoside analogues in utero: The french experience. ENVIRONMENTAL AND MOLECULAR MUTAGENESIS 2019; 60:404-409. [PMID: 29206312 DOI: 10.1002/em.22162] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Revised: 11/03/2017] [Accepted: 11/15/2017] [Indexed: 05/23/2023]
Abstract
All nucleoside analogues for treating HIV infection, due to their capacity to integrate into and alter human DNA, are experimentally genotoxic to some extent. The long-term oncogenic risk after in utero exposure remains to be determined. Cancer incidence in uninfected children exposed to nucleos(t)ide reverse transcriptase inhibitors (NRTIs) was evaluated, by cross-checking against the National Cancer Registry, in the French perinatal study of children born to HIV+ mothers. Twenty-one cancers were identified in 15,163 children (median age: 9.9 years [interquartile range (IQR): 5.8-14.2]) exposed to at least one NRTI in utero between 1990 and 2014. Five of these children were exposed to zidovudine monotherapy, and 15 to various combinations, seven of which included didanosine. Overall, the total number of cases was not significantly different from that expected for the general population (SIR = 0.8[0.47-1.24]), but the number of cases after didanosine exposure was twice that expected (SIR = 2.5 [1.01-5.19]). Didanosine accounted for only 10% of prescriptions but was associated with one-third of cancers. In multivariate analysis, didanosine exposure was significantly associated with higher risk (HR = 3.0 [0.9-9.8]). This risk was specifically linked to first-trimester exposure (HR = 5.5 [2.1-14.4]). Three cases of pineoblastoma, a very rare cancer, were observed, whereas 0.03 were expected. Two were associated with didanosine exposure. Despite reassuring data overall, there is strong evidence to suggest that didanosine displays transplacental oncogenicity. These findings cannot be extrapolated to other NRTIs, but they highlight the need for comprehensive evaluations of the transplacental genotoxicity of this antiretroviral class. Environ. Mol. Mutagen., 60:404-409, 2019. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Mira Hleyhel
- Epidemiology and Population Health Center, Institut National de la Santé et de la Recherche Médicale (INSERM), Le Kremlin-Bicêtre, U1018, France
| | - Stéphanie Goujon
- Epidemiology of Childhood and Adolescent Cancers Team (EPICEA), Université Paris Descartes, Epidemiology and Biostatistics, INSERM UMR1153, Sorbonne Paris Cité Research Center, Villejuif, France
- French National Registry of Childhood Cancers, Villejuif, France
| | - Jeanne Sibiude
- Gynecology and Obstetrics Department, Hôpital Louis Mourier, Hôpitaux Universitaires Paris Nord Val de Seine, AP-HP, Colombes, France
| | - Roland Tubiana
- Infectious Diseases Department, Hôpital Pitié Salpétrière, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | | | - Albert Faye
- Pediatric Department, Hôpital Robert Debré, AP-HP, Université Paris Diderot, Sorbonne Paris-Cité, Paris, France
| | - Laurent Mandelbrot
- Gynecology and Obstetrics Department, Hôpital Louis Mourier, Hôpitaux Universitaires Paris Nord Val de Seine, AP-HP, Colombes, France
| | - Jacqueline Clavel
- Epidemiology of Childhood and Adolescent Cancers Team (EPICEA), Université Paris Descartes, Epidemiology and Biostatistics, INSERM UMR1153, Sorbonne Paris Cité Research Center, Villejuif, France
- French National Registry of Childhood Cancers, Villejuif, France
| | - Josiane Warszawski
- Epidemiology and Population Health Center, Institut National de la Santé et de la Recherche Médicale (INSERM), Le Kremlin-Bicêtre, U1018, France
- Hôpital Bicêtre, AP-HP, Université Paris Sud, Le Kremlin-Bicêtre, France
| | - Stéphane Blanche
- Immunology Hematology Rheumatology Unit, Pediatric Department, Hôpital Necker-Enfants Malades AP-HP, Université Paris Descartes, Paris, France
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Amer MAI, Elatrozy HIS. Combined endoscopic third ventriculostomy and tumor biopsy in the management of pineal region tumors, safety considerations. EGYPTIAN JOURNAL OF NEUROSURGERY 2018. [DOI: 10.1186/s41984-018-0022-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Zaazoue MA, Goumnerova LC. Pineal region tumors: a simplified management scheme. Childs Nerv Syst 2016; 32:2041-2045. [PMID: 27476035 DOI: 10.1007/s00381-016-3157-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Accepted: 06/26/2016] [Indexed: 12/19/2022]
Affiliation(s)
- Mohamed A Zaazoue
- Department of Neurosurgery, Boston Children's Hospital, 300 Longwood Avenue, Hunnewell 2, Boston, MA, 02115, USA
| | - Liliana C Goumnerova
- Department of Neurosurgery, Boston Children's Hospital, 300 Longwood Avenue, Hunnewell 2, Boston, MA, 02115, USA.
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Abstract
BACKGROUND Evaluation of long-term tolerance to antiretroviral exposure during pregnancy is required. An increased risk of cancer has been suggested in children exposed in utero to didanosine. METHODS Updated evaluation of cancer incidence in uninfected children exposed to nucleos(t)ide reverse transcriptase inhibitors (NRTIs) in the French perinatal study of children born to HIV+ mothers, by cross-checking with the National Cancer Registry. Associations between cancer risk and exposure to NRTIs were evaluated by univariate survival analysis and Cox proportional hazard models. Standardized incidence ratios (SIR) were used for comparison with the general population. RESULTS A total of 21 cancers were identified in 15 163 children (median age: 9.9 years [interquartile range (IQR): 5.8-14.2]) exposed to at least one NRTI in utero, between 1990 and 2014. Five children were exposed to zidovudine monotherapy, and 16 to various combinations, seven including didanosine. Didanosine accounted for only 10% of prescriptions but was associated with one-third of cancers. In a multivariate analysis, didanosine exposure was significantly associated with higher risk [hazard ratio = 3.0 (0.9-9.8)]. The risk was specifically linked with first-trimester exposure [hazard ratio = 5.5 (2.1-14.4)]. Overall, the total number of cases was not significantly different from that expected for the general population [SIR = 0.8 (0.47-1.24)], but was twice that expected after didanosine exposure [SIR = 2.5 (1.01-5.19)]. CONCLUSION There are strong arguments to suggest that didanosine displays transplacental oncogenicity. Although not extrapolable to other NRTIs, they stress the need for comprehensive evaluation of the transplacental genotoxicity of this antiretroviral class.
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Rare Presentation of Supratentorial Primitive Neuroectodermal Tumors Mimicking Bifocal Germ Cell Tumors: 2 Case Reports. J Pediatr Hematol Oncol 2016; 38:e67-70. [PMID: 26241725 DOI: 10.1097/mph.0000000000000402] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Bifocal pineal and suprasellar tumors have only been described in the context of germ cell tumors in the pediatric age group. We report 2 patients with radiologic findings of bifocal pineal and suprasellar lesions, with a histologic diagnosis of supratentorial primitive neuroectodermal tumor. The absence of diabetes insipidus and other endocrine abnormalities was noteworthy in both cases. This observation challenges previous reports on the pathognomonic value of this clinico-radiologic entity.
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Pineal tumours: Experience of the French National Register and the Lyon School, results and considerations. Neurochirurgie 2015; 61:223-35. [DOI: 10.1016/j.neuchi.2014.02.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Revised: 11/21/2013] [Accepted: 02/18/2014] [Indexed: 12/29/2022]
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Deiana G, Mottolese C, Hermier M, Louis-Tisserand G, Berthezene Y. Imagery of pineal tumors. Neurochirurgie 2015; 61:113-22. [DOI: 10.1016/j.neuchi.2014.10.111] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Revised: 10/13/2014] [Accepted: 10/15/2014] [Indexed: 12/26/2022]
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Mottolese C, Szathmari A, Beuriat PA. Incidence of pineal tumours. A review of the literature. Neurochirurgie 2014; 61:65-9. [PMID: 25113513 DOI: 10.1016/j.neuchi.2014.01.005] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Revised: 01/13/2014] [Accepted: 01/24/2014] [Indexed: 11/25/2022]
Abstract
The knowledge of the incidence of pineal tumours is important not only for diagnostic care but also for its therapeutic programme. We reviewed the incidence of pineal tumours reported in literature in an attempt to establish if a difference existed between pineal gland tumours and the pineal region tumours as different authors use both expressions to indicate the same thing. The rate of frequency of these tumours is useful to guide the therapeutic choice for patients as the decisional tree is completely different for either germ cell tumours, pineal gland tumours or pineal gliomas and eventually papillary tumours of the pineal region. According to the French Register of pineal tumours, true pineal tumours represent: 27% pineal parenchymal tumours (PPT), 27% germ cell tumours, 17% gliomas, 8% papillary tumours. True pineal gland tumours are represented by: pineocytomas - (13%), pineal parenchymal tumours with intermediary differentiation PTT-ID - (66%) and pinealoblastomas - (21%). There was no statistical difference found between the French register and the Lyon series concerning histological diagnosis. It seemed to us important to discover its true incidence by comparing the data published in the literature and to stress the utility of the French Register for these uncommon tumours not only for recording new histological cases but also to document clinical symptomatology, therapeutic programmes, length of follow-up and clinical results for each patient treated. A better understanding of their natural history and improved evaluation of different treatments and their complications should contribute to improve clinical results.
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Affiliation(s)
- C Mottolese
- Neurological and Neurosurgical Hospital « P. Wertheimer », Pediatric Neurosurgery E, 59, boulevard Pinel, 69677 Bron, France.
| | - A Szathmari
- Neurological and Neurosurgical Hospital « P. Wertheimer », Pediatric Neurosurgery E, 59, boulevard Pinel, 69677 Bron, France
| | - P-A Beuriat
- Neurological and Neurosurgical Hospital « P. Wertheimer », Pediatric Neurosurgery E, 59, boulevard Pinel, 69677 Bron, France
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16
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Farnia B, Allen PK, Brown PD, Khatua S, Levine NB, Li J, Penas-Prado M, Mahajan A, Ghia AJ. Clinical outcomes and patterns of failure in pineoblastoma: a 30-year, single-institution retrospective review. World Neurosurg 2014; 82:1232-41. [PMID: 25045788 DOI: 10.1016/j.wneu.2014.07.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Accepted: 07/15/2014] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To update outcomes and assess prognostic factors in the modern, multimodality treatment of patients with pineoblastoma. METHODS The medical records of patients with pineoblastoma evaluated at the M.D. Anderson Cancer Center between 1982 and 2012 were reviewed retrospectively. RESULTS Thirty-one patients with medical records suitable for review were identified. The majority of patients were female (67.7%) with a median age at diagnosis of 18.2 years (range, 0.3-52.8 years). Twenty-one patients underwent surgical resection, recorded as gross total (n = 9) or subtotal (n = 12) resections. Thirty patients received radiation with photon-based therapy (n = 16), proton-based therapy (n = 13), or radiosurgery (n = 1) to a median craniospinal irradiation dose of 36 Gy (range, 23.4-40 Gy) and a median focal dose of 54 Gy (range, 40-58.4 Gy). Twenty-eight patients received chemotherapy before (n = 10), during (n = 10), and after (n = 22) radiation. Median overall survival was 8.7 years for the entire cohort, with 2-, 5-, and 10- year actuarial rates of 89.5%, 69.4%, and 48.6%, respectively. Median disease-free survival was 10 years with 2-, 5-, and 10- year actuarial rates of 84.3%, 62.6%, and 55.7%, respectively. Univariate analysis failed to correlate age, sex, or extent of surgical resection with disease-free or overall survival. CONCLUSIONS Modern, multimodality treatment of pineoblastoma yields a high rate of overall survival, with acceptable short- and long-term toxicity. A greater M-stage at presentation and development of disease recurrence correlate with worse overall survival. Patients who received focal radiation initially experienced a greater rate of disease recurrence compared with those treated to the craniospinal axis.
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Affiliation(s)
- Benjamin Farnia
- Department of Radiation Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA
| | - Pamela K Allen
- Department of Radiation Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA
| | - Paul D Brown
- Department of Radiation Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA
| | - Soumen Khatua
- Department of Pediatrics, The University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA
| | - Nicholas B Levine
- Department of Neurosurgery, The University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA
| | - Jing Li
- Department of Radiation Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA
| | - Marta Penas-Prado
- Department of Neuro-Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA
| | - Anita Mahajan
- Department of Radiation Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA
| | - Amol J Ghia
- Department of Radiation Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas, USA.
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17
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Fontana EJ, Garvin J, Feldstein N, Anderson RCE. Pediatric considerations for pineal tumor management. Neurosurg Clin N Am 2012; 22:395-402, ix. [PMID: 21801988 DOI: 10.1016/j.nec.2011.05.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Pineal tumors are relatively rare central nervous system lesions with a predilection for the pediatric population. For the vast majority of these lesions, surgical resection is a critical step in effective treatment. This article discusses current strategies for preoperative evaluation, operative management, and postoperative care of the pediatric patient with a newly diagnosed pineal region tumor.
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Affiliation(s)
- E J Fontana
- Department of Neurological Surgery, Neurological Institute, Columbia University Medical Center, New York, NY 10036, USA.
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18
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Taschner CA, Staszewski O, van Velthoven V, Müller M, Kontny U, Hader C, Prinz M. Freiburg neuropathology case conference: a midline mass lesion in an infant. Clin Neuroradiol 2011; 21:101-6. [PMID: 21769656 DOI: 10.1007/s00062-011-0085-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This article presents the case of a 10-month-old baby girl with an atypical teratoid/rhabdoid tumor. The differential diagnosis relied on the findings from magnetic resonance with T1 and T2-weighted imaging as well as histological and immunohistochemical methods. The characteristics of the possible candidate lesions considered for the differential diagnosis are described.
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Affiliation(s)
- C A Taschner
- Department of Neuroradiology, University Hospital Freiburg, Freiburg, Germany.
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Morgenstern PF, Osbun N, Schwartz TH, Greenfield JP, Tsiouris AJ, Souweidane MM. Pineal region tumors: an optimal approach for simultaneous endoscopic third ventriculostomy and biopsy. Neurosurg Focus 2011; 30:E3. [DOI: 10.3171/2011.2.focus10301] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
Simultaneous endoscopic third ventriculostomy (ETV) and tumor biopsy is a widely accepted therapeutic and diagnostic procedure for patients with noncommunicating hydrocephalus secondary to a pineal region tumor. Multiple approaches have been advocated, including the use of a steerable fiberoptic or rigid lens endoscope via 1 or 2 trajectories. However, the optimal approach has not been established based on the individual anatomical characteristics of the patient.
Methods
A retrospective review of patients undergoing simultaneous ETV and tumor biopsy was undertaken. Preoperative MR images were examined to measure the width of the anterior third ventricle and maximal diameters of the tumor, Monro foramen (right), and massa intermedia. The distances between the tumor and massa intermedia, tumor and anterior commissure, midbrain and massa intermedia, and the dorsum sella and anterior commissure were also recorded. Single and dual trajectory approaches were compared using paired t-tests for each parameter.
Results
Over an 8-year interval, 15 patients underwent simultaneous ETV and tumor management. These patients ranged from 6 to 71 years of age (mean 36.7 years); 5 were younger than 18 years of age. Seven were treated using a dual trajectory approach, and 8 were treated using a single trajectory approach. All cases were completed without complications or the need for an additional CSF diversionary procedure within 6 months. The diagnostic yield at biopsy was 86.7%. There were no statistically significant differences between the single and dual trajectory groups for the measured parameters. However, the dual trajectory group demonstrated a larger anterior third ventricular diameter (1.43 vs 1.21 cm, p = 0.29). The single trajectory group trended toward a smaller tumor–anterior commissure interval (2.23 vs 2.51 cm, p = 0.24) and a larger dorsum sella–anterior commissure distance (1.67 vs 1.49 cm, p = 0.28).
Conclusions
These data confirm the safety and diagnostic efficacy of simultaneous ETV and biopsy for tumors of the pineal region. Although no statistically significant differences were seen in the authors' recorded measurements, several trends suggest a role for a tailored approach to selecting a single or dual trajectory approach when using a rigid endoscope.
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