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Dias SF, Richards O, Elliot M, Chumas P. Pediatric-Like Brain Tumors in Adults. Adv Tech Stand Neurosurg 2024; 50:147-183. [PMID: 38592530 DOI: 10.1007/978-3-031-53578-9_5] [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
Pediatric brain tumors are different to those found in adults in pathological type, anatomical site, molecular signature, and probable tumor drivers. Although these tumors usually occur in childhood, they also rarely present in adult patients, either as a de novo diagnosis or as a delayed recurrence of a pediatric tumor in the setting of a patient that has transitioned into adult services.Due to the rarity of pediatric-like tumors in adults, the literature on these tumor types in adults is often limited to small case series, and treatment decisions are often based on the management plans taken from pediatric studies. However, the biology of these tumors is often different from the same tumors found in children. Likewise, adult patients are often unable to tolerate the side effects of the aggressive treatments used in children-for which there is little or no evidence of efficacy in adults. In this chapter, we review the literature and summarize the clinical, pathological, molecular profile, and response to treatment for the following pediatric tumor types-medulloblastoma, ependymoma, craniopharyngioma, pilocytic astrocytoma, subependymal giant cell astrocytoma, germ cell tumors, choroid plexus tumors, midline glioma, and pleomorphic xanthoastrocytoma-with emphasis on the differences to the adult population.
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Affiliation(s)
- Sandra Fernandes Dias
- Department of Neurosurgery, Leeds Teaching Hospitals NHS Trust, Leeds, UK
- Division of Pediatric Neurosurgery, University Children's Hospital of Zurich - Eleonor Foundation, Zurich, Switzerland
| | - Oliver Richards
- Department of Neurosurgery, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Martin Elliot
- Department of Paediatric Oncology and Haematology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Paul Chumas
- Department of Neurosurgery, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
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Adamski J, Langford V, Finlay JL. Approaches to Minimise the Neurodevelopmental Impact of Choroid Plexus Carcinoma and Its Treatment. Life (Basel) 2023; 13:1855. [PMID: 37763259 PMCID: PMC10533047 DOI: 10.3390/life13091855] [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: 07/06/2023] [Revised: 08/03/2023] [Accepted: 08/04/2023] [Indexed: 09/29/2023] Open
Abstract
Choroid plexus carcinomas (CPC) are rare aggressive tumours that primarily affect very young children. Treatment for CPC typically involves a combination of surgery, chemotherapy, and radiation therapy. Whilst considered necessary for a cure, these therapies have significant neurocognitive consequences for patients, negatively impacting cognitive function including memory, attention, executive functioning, and full-scale intelligence quotients (FSIQ). These challenges significantly impact the quality of life and ultimately socioeconomic parameters such as the level of educational attainment, marital status, and socioeconomic status. This review looks at the tumour- and treatment-related causes of neurocognitive damage in CPC patients and the progress made in finding strategies to reduce these. Opportunities to mitigate the neurodevelopmental consequences of surgery, chemotherapy, and radiation therapy are explored in the context of CPC treatment. Evaluation of the pathological and biological mechanisms of injury has identified innovative approaches to neurocognitive protection and neurorehabilitation, which aim to limit the neurocognitive damage. This review aims to highlight multiple approaches physicians can use when treating young children with CPC, to focus on neurocognitive outcomes as a measure of success.
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Affiliation(s)
- Jenny Adamski
- Birmingham Women’s and Children’s Hospital NHS Foundation Trust, Birmingham B4 6NH, UK;
| | - Vikki Langford
- Birmingham Women’s and Children’s Hospital NHS Foundation Trust, Birmingham B4 6NH, UK;
| | - Jonathan L. Finlay
- Ohio State University College of Medicine, The Ohio State University, Columbus, OH 43210, USA;
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Martin B, Garman T, Laramee M, Wang A, Zhang X, Beck E, Wilson K, Klumpp-Thomas C, McKnight C, Xu X, Hagen N, Holland D, Dahmane N, Thomas CJ, Souweidane M. Preclinical validation of a novel therapeutic strategy for choroid plexus carcinoma. J Control Release 2023; 357:580-590. [PMID: 37054779 PMCID: PMC10174050 DOI: 10.1016/j.jconrel.2023.04.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 03/29/2023] [Accepted: 04/09/2023] [Indexed: 04/15/2023]
Abstract
Choroid plexus carcinoma (CPC) is a rare infantile brain tumor with an aggressive clinical course that often leaves children with debilitating side effects due to aggressive and toxic chemotherapies. Development of novel therapeutical strategies for this disease have been extremely limited owing to the rarity of the disease and the paucity of biologically relevant substrates. We conducted the first high-throughput screen (HTS) on a human patient-derived CPC cell line (Children Cancer Hospital Egypt, CCHE-45) and identified 427 top hits highlighting key molecular targets in CPC. Furthermore, a combination screen with a wide variety of targets revealed multiple synergistic combinations that may pave the way for novel therapeutical strategies against CPC. Based on in vitro efficiency, central nervous system (CNS) penetrance ability and feasible translational potential, two combinations using a DNA alkylating or topoisomerase inhibitors in combination with an ataxia telangiectasia mutated and rad3 (ATR) inhibitor (topotecan/elimusertib and melphalan/elimusertib respectively) were validated in vitro and in vivo. Pharmacokinetic assays established increased brain penetrance with intra-arterial (IA) delivery over intra-venous (IV) delivery and demonstrated a higher CNS penetrance for the combination melphalan/elimusertib. The mechanisms of synergistic activity for melphalan/elimusertib were assessed through transcriptome analyses and showed dysregulation of key oncogenic pathways (e.g. MYC, mammalian target of rapamycin mTOR, p53) and activation of critical biological processes (e.g. DNA repair, apoptosis, hypoxia, interferon gamma). Importantly, IA administration of melphalan combined with elimusertib led to a significant increase in survival in a CPC genetic mouse model. In conclusion, this study is, to the best of our knowledge, the first that identifies multiple promising combinatorial therapeutics for CPC and emphasizes the potential of IA delivery for the treatment of CPC.
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Affiliation(s)
- Brice Martin
- Department of Neurological Surgery, Weill Cornell Medicine, New York, NY 10065, USA.
| | - Tyler Garman
- Department of Neurological Surgery, Weill Cornell Medicine, New York, NY 10065, USA
| | - Madeline Laramee
- Department of Neurological Surgery, Weill Cornell Medicine, New York, NY 10065, USA
| | - Amy Wang
- Division of National Toxicology, National Center for Advancing Translational Sciences, National Institutes of Health, Rockville, MD 20850, USA; Division of Preclinical Innovation, National Center for Advancing Translational Sciences, National Institutes of Health, Rockville, MD 20850, USA
| | - Xiaohu Zhang
- Division of Preclinical Innovation, National Center for Advancing Translational Sciences, National Institutes of Health, Rockville, MD 20850, USA
| | - Erin Beck
- Division of Preclinical Innovation, National Center for Advancing Translational Sciences, National Institutes of Health, Rockville, MD 20850, USA
| | - Kelli Wilson
- Division of Preclinical Innovation, National Center for Advancing Translational Sciences, National Institutes of Health, Rockville, MD 20850, USA
| | - Carleen Klumpp-Thomas
- Division of Preclinical Innovation, National Center for Advancing Translational Sciences, National Institutes of Health, Rockville, MD 20850, USA
| | - Crystal McKnight
- Division of Preclinical Innovation, National Center for Advancing Translational Sciences, National Institutes of Health, Rockville, MD 20850, USA
| | - Xin Xu
- Division of National Toxicology, National Center for Advancing Translational Sciences, National Institutes of Health, Rockville, MD 20850, USA; Division of Preclinical Innovation, National Center for Advancing Translational Sciences, National Institutes of Health, Rockville, MD 20850, USA
| | - Natalie Hagen
- Division of National Toxicology, National Center for Advancing Translational Sciences, National Institutes of Health, Rockville, MD 20850, USA
| | - David Holland
- Division of Preclinical Innovation, National Center for Advancing Translational Sciences, National Institutes of Health, Rockville, MD 20850, USA; Lymphoid Malignancies Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Nadia Dahmane
- Department of Neurological Surgery, Weill Cornell Medicine, New York, NY 10065, USA
| | - Craig J Thomas
- Division of Preclinical Innovation, National Center for Advancing Translational Sciences, National Institutes of Health, Rockville, MD 20850, USA; Lymphoid Malignancies Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
| | - Mark Souweidane
- Department of Neurological Surgery, Weill Cornell Medicine, New York, NY 10065, USA; Department of Neurosurgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
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Spennato P, De Martino L, Russo C, Errico ME, Imperato A, Mazio F, Miccoli G, Quaglietta L, Abate M, Covelli E, Donofrio V, Cinalli G. Tumors of Choroid Plexus and Other Ventricular Tumors. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1405:175-223. [PMID: 37452939 DOI: 10.1007/978-3-031-23705-8_7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
Tumors arising inside the ventricular system are rare but represent a difficult diagnostic and therapeutic challenge. They usually are diagnosed when reaching a big volume and tend to affect young children. There is a wide broad of differential diagnoses with significant variability in anatomical aspects and tumor type. Differential diagnosis in tumor type includes choroid plexus tumors (papillomas and carcinomas), ependymomas, subependymomas, subependymal giant cell astrocytomas (SEGAs), central neurocytomas, meningiomas, and metastases. Choroid plexus tumors, ependymomas of the posterior fossa, and SEGAs are more likely to appear in childhood, whereas subependymomas, central neurocytomas, intraventricular meningiomas, and metastases are more frequent in adults. This chapter is predominantly focused on choroid plexus tumors and radiological and histological differential diagnosis. Treatment is discussed in the light of the modern acquisition in genetics and epigenetics of brain tumors.
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Affiliation(s)
- Pietro Spennato
- Department of Pediatric Neurosurgery, Santobono-Pausilipon Children's Hospital, Via Mario Fiore 6, 80121, Naples, Italy.
| | - Lucia De Martino
- Department of Pediatric Oncology, Santobono-Pausilipon Pediatric Hospital, Naples, Italy
| | - Carmela Russo
- Department of Neuroradiology, Santobono-Pausilipon Pediatric Hospital, Naples, Italy
| | - Maria Elena Errico
- Department of Pathology, Santobono-Pausilipon Pediatric Hospital, Naples, Italy
| | - Alessia Imperato
- Department of Pediatric Neurosurgery, Santobono-Pausilipon Children's Hospital, Via Mario Fiore 6, 80121, Naples, Italy
| | - Federica Mazio
- Department of Neuroradiology, Santobono-Pausilipon Pediatric Hospital, Naples, Italy
| | - Giovanni Miccoli
- Department of Pediatric Neurosurgery, Santobono-Pausilipon Children's Hospital, Via Mario Fiore 6, 80121, Naples, Italy
| | - Lucia Quaglietta
- Department of Pediatric Oncology, Santobono-Pausilipon Pediatric Hospital, Naples, Italy
| | - Massimo Abate
- Department of Pediatric Oncology, Santobono-Pausilipon Pediatric Hospital, Naples, Italy
| | - Eugenio Covelli
- Department of Neuroradiology, Santobono-Pausilipon Pediatric Hospital, Naples, Italy
| | - Vittoria Donofrio
- Department of Pathology, Santobono-Pausilipon Pediatric Hospital, Naples, Italy
| | - Giuseppe Cinalli
- Department of Pediatric Neurosurgery, Santobono-Pausilipon Children's Hospital, Via Mario Fiore 6, 80121, Naples, Italy
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Voelker A, Osterhoff G, Einhorn S, Ebel S, Heyde CE, Pieroh P. Does the anatomical region predict blood loss or neurological deficits in embolized renal cancer spine metastases? A single-center experience with 31 patients. World J Surg Oncol 2022; 20:208. [PMID: 35710422 PMCID: PMC9202195 DOI: 10.1186/s12957-022-02676-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 06/06/2022] [Indexed: 11/13/2022] Open
Abstract
Background No comparison of a single hypervascular tumor entity in terms of major complications in different spinal regions has been performed. We aimed to evaluate post-embolic and post-operative outcomes in anatomic regions with renal cell carcinoma (RCC) metastases to the spine. Methods We retrospectively evaluated data from patients with confirmed, embolized, and surgically treated RCC spine metastases at a single-spine center between 2010 and 2020. Patients were divided into thoracic (TSM) and lumbar (LSM) spine metastasis groups. Results Seventeen patients had TSM and 14 had LSM. In all cases, embolization was performed preoperatively. The ΔHb value did not differ between the two groups pre- and postoperatively (p=0.3934). There was no significant difference in intraoperative blood loss between both groups either within 1 day or 2 days after embolization. Neurological deficits occurred in eight patients after embolization or surgery, with no significant difference between TSM (n=5) and LSM (n=3). Conclusions Embolization is the standard procedure for the preoperative treatment of hypervascular spinal metastases, possible up to 48 h before surgery, without the risk of higher intraoperative blood loss. Regardless of intraoperative complications, major complications can occur up to several hours after embolization. We recommend surgery the day after embolization to reliably detect neurologic complications from this procedure.
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Affiliation(s)
- Anna Voelker
- Department of Orthopedics, Trauma and Plastic Surgery, University Hospital Leipzig, Liebigstraße 20, 04103, Leipzig, Germany.
| | - Georg Osterhoff
- Department of Orthopedics, Trauma and Plastic Surgery, University Hospital Leipzig, Liebigstraße 20, 04103, Leipzig, Germany
| | - Stefanie Einhorn
- Department of Orthopedics, Trauma and Plastic Surgery, University Hospital Leipzig, Liebigstraße 20, 04103, Leipzig, Germany
| | - Sebastian Ebel
- Department of Radiology, University Hospital Leipzig, Liebigstraße 20, 04103, Leipzig, Germany
| | - Christoph-Eckhard Heyde
- Department of Orthopedics, Trauma and Plastic Surgery, University Hospital Leipzig, Liebigstraße 20, 04103, Leipzig, Germany
| | - Philipp Pieroh
- Department of Orthopedics, Trauma and Plastic Surgery, University Hospital Leipzig, Liebigstraße 20, 04103, Leipzig, Germany
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Final results of the Choroid Plexus Tumor study CPT-SIOP-2000. J Neurooncol 2022; 156:599-613. [PMID: 34997889 PMCID: PMC8860833 DOI: 10.1007/s11060-021-03942-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 12/31/2021] [Indexed: 11/25/2022]
Abstract
Introduction Standards for chemotherapy against choroid plexus tumors (CPT) have not yet been established. Methods CPT-SIOP-2000 (NCT00500890) was an international registry for all CPT nesting a chemotherapy randomization for high-risk CPT with Carboplatin/Etoposide/Vincristine (CarbEV) versus Cyclophosphamide/Etoposide/Vincristine (CycEV). Patients older than three years were recommended to receive irradiation: focal fields for non-metastatic CPC, incompletely resected atypical choroid plexus papilloma (APP) or metastatic choroid plexus papilloma (CPP); craniospinal fields for metastatic CPC/APP and non-responsive CPC. High risk was defined as choroid plexus carcinoma (CPC), incompletely resected APP, and all metastatic CPT. From 2000 until 2010, 158 CPT patients from 23 countries were enrolled. Results For randomized CPC, the 5/10 year progression free survival (PFS) of patients on CarbEV (n = 20) were 62%/47%, respectively, compared to 27%/18%, on CycEV (n = 15), (intention-to-treat, HR 2.6, p = 0.032). Within the registry, histological grading was the most influential prognostic factor: for CPP (n = 55) the 5/10 year overall survival (OS) and the event free survival (EFS) probabilities were 100%/97% and 92%/92%, respectively; for APP (n = 49) 96%/96% and 76%/76%, respectively; and for CPC (n = 54) 65%/51% and 41%/39%, respectively. Without irradiation, 12 out of 33 patients with CPC younger than three years were alive for a median of 8.52 years. Extent of surgery and metastases were not independent prognosticators. Conclusions Chemotherapy for Choroid Plexus Carcinoma is feasible and effective. CarbEV is superior to CycEV. A subset of CPC can be cured without irradiation. Supplementary Information The online version contains supplementary material available at 10.1007/s11060-021-03942-0.
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Baro V, Gabrieli JD, Cester G, D’Errico I, Landi A, Denaro L, Causin F. Preoperative Devascularization of Choroid Plexus Tumors: Specific Issues about Anatomy and Embolization Technique. Brain Sci 2021; 11:brainsci11050540. [PMID: 33922937 PMCID: PMC8146914 DOI: 10.3390/brainsci11050540] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 04/22/2021] [Accepted: 04/23/2021] [Indexed: 11/16/2022] Open
Abstract
(1) Background: Surgical treatment of choroid plexus tumors is challenging, burdened by a notable risk of bleeding. Neoadjuvant chemotherapy and preoperative embolization have been attempted, with encouraging results; however, the consensus on these procedures is lacking. (2) Methods: We present a case of a 10-month-old girl who underwent preoperative embolization of a hemorrhagic choroid plexus carcinoma of the lateral ventricle via the anterior choroidal artery, followed by total resection. (3) Results: The endovascular procedure was successfully completed, despite the rectification of the anterior choroidal artery associated with the absence of flow proximal to the plexal point. Minimal bleeding was observed during resection and the patient remained neurologically intact. (4) Conclusions: The time from entrance to exit in the anterior choroidal artery should be monitored and regarded as a potential 'occlusion time' in this specific group of patients. Nevertheless, our case supports the feasibility and effectiveness of preoperative embolization of a choroid plexus carcinoma of the lateral ventricle via the anterior choroidal artery, without complications. Furthermore, we suggest the use of a fast-embolic agent, such as N-butyl cyanoacrylate glue, as the preferred agent for this specific pathology and patient population.
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Affiliation(s)
- Valentina Baro
- Academic Neurosurgery, Department of Neuroscience, University of Padova, 35100 Padova, Italy; (A.L.); (L.D.)
- Correspondence:
| | - Joseph Domenico Gabrieli
- Neuroradiology Unit, University of Padova, 35100 Padova, Italy; (J.D.G.); (G.C.); (I.D.); (F.C.)
| | - Giacomo Cester
- Neuroradiology Unit, University of Padova, 35100 Padova, Italy; (J.D.G.); (G.C.); (I.D.); (F.C.)
| | - Ignazio D’Errico
- Neuroradiology Unit, University of Padova, 35100 Padova, Italy; (J.D.G.); (G.C.); (I.D.); (F.C.)
| | - Andrea Landi
- Academic Neurosurgery, Department of Neuroscience, University of Padova, 35100 Padova, Italy; (A.L.); (L.D.)
| | - Luca Denaro
- Academic Neurosurgery, Department of Neuroscience, University of Padova, 35100 Padova, Italy; (A.L.); (L.D.)
| | - Francesco Causin
- Neuroradiology Unit, University of Padova, 35100 Padova, Italy; (J.D.G.); (G.C.); (I.D.); (F.C.)
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Jameel PZ, Varma A, Kumari P, Vagha K, Vagha J, Damke S. Choroid plexus carcinoma in an adolescent male: a case report. J Med Case Rep 2021; 15:184. [PMID: 33879216 PMCID: PMC8058991 DOI: 10.1186/s13256-021-02801-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 03/18/2021] [Indexed: 11/28/2022] Open
Abstract
Introduction/background Although central nervous system tumors are the most common etiology of malignancies in the pediatric age group, choroid plexus carcinomas are rare, with an annual incidence rate of 0.10 per 100,000 children. Case presentation We report the case of an adolescent male belonging to central India who had presented with a history of persistent headache, projectile vomiting, neck stiffness, and an episode of generalized tonic-clonic seizure. Neurological examination was suggestive of a space-occupying lesion. Further neuroimaging was suggestive of a large left-sided choroid plexus carcinoma, later confirmed on pathological examination. Gross total resection was achieved and followed by radiation therapy. His recovery was satisfactory without any major events despite suffering from such a malignancy with a poor prognosis. Conclusion In the absence of a global consensus on choroid plexus carcinoma management, our patient underwent a successful gross total resection and received postoperative radiotherapy. He made a satisfactory recovery with a further plan to review with gadolinium-enhanced neuroimaging at a later date. We conclude that, when possible, achieving gross total resection is of utmost importance.
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Affiliation(s)
- Patel Zeeshan Jameel
- Department of Paediatrics, Jawaharlal Nehru Medical College, Sawangi (Meghe), Wardha, Maharashtra, 442001, India.
| | - Ashish Varma
- Department of Paediatrics, Jawaharlal Nehru Medical College, Sawangi (Meghe), Wardha, Maharashtra, 442001, India
| | - Pooja Kumari
- Department of Paediatrics, Jawaharlal Nehru Medical College, Sawangi (Meghe), Wardha, Maharashtra, 442001, India
| | - Keta Vagha
- Department of Paediatrics, Jawaharlal Nehru Medical College, Sawangi (Meghe), Wardha, Maharashtra, 442001, India
| | - Jayant Vagha
- Department of Paediatrics, Jawaharlal Nehru Medical College, Sawangi (Meghe), Wardha, Maharashtra, 442001, India
| | - Sachin Damke
- Department of Paediatrics, Jawaharlal Nehru Medical College, Sawangi (Meghe), Wardha, Maharashtra, 442001, India
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Frank N, Beinemann J, Thieringer FM, Benitez BK, Kunz C, Guzman R, Soleman J. The need for overcorrection: evaluation of computer-assisted, virtually planned, fronto-orbital advancement using postoperative 3D photography. Neurosurg Focus 2021; 50:E5. [PMID: 33794499 DOI: 10.3171/2021.1.focus201026] [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: 12/01/2020] [Accepted: 01/07/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The main indication for craniofacial remodeling of craniosynostosis is to correct the deformity, but potential increased intracranial pressure resulting in neurocognitive damage and neuropsychological disadvantages cannot be neglected. The relapse rate after fronto-orbital advancement (FOA) seems to be high; however, to date, objective measurement techniques do not exist. The aim of this study was to quantify the outcome of FOA using computer-assisted design (CAD) and computer-assisted manufacturing (CAM) to create individualized 3D-printed templates for correction of craniosynostosis, using postoperative 3D photographic head and face surface scans during follow-up. METHODS The authors included all patients who underwent FOA between 2014 and 2020 with individualized, CAD/CAM-based, 3D-printed templates and received postoperative 3D photographic face and head scans at follow-up. Since 2016, the authors have routinely planned an additional "overcorrection" of 3 mm to the CAD-based FOA correction of the affected side(s). The virtually planned supraorbital angle for FOA correction was compared with the postoperative supraorbital angle measured on postoperative 3D photographic head and face surface scans. The primary outcome was the delta between the planned CAD/CAM FOA correction and that achieved based on 3D photographs. Secondary outcomes included outcomes with and those without "overcorrection," time of surgery, blood loss, and morbidity. RESULTS Short-term follow-up (mean 9 months after surgery; 14 patients) showed a delta of 12° between the planned and achieved supraorbital angle. Long-term follow-up (mean 23 months; 8 patients) showed stagnant supraorbital angles without a significant increase in relapse. Postsurgical supraorbital angles after an additionally planned overcorrection (of 3 mm) of the affected side showed a mean delta of 11° versus 14° without overcorrection. The perioperative and postoperative complication rates of the whole cohort (n = 36) were very low, and the mean (SD) intraoperative blood loss was 128 (60) ml with a mean (SD) transfused red blood cell volume of 133 (67) ml. CONCLUSIONS Postoperative measurement of the applied FOA on 3D photographs is a feasible and objective method for assessment of surgical results. The delta between the FOA correction planned with CAD/CAM and the achieved correction can be analyzed on postoperative 3D photographs. In the future, calculation of the amount of "overcorrection" needed to avoid relapse of the affected side(s) after FOA may be possible with the aid of these techniques.
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Affiliation(s)
| | - Joerg Beinemann
- 2Oral and Craniomaxillofacial Surgery, University Hospital of Basel
| | | | - Benito K Benitez
- 2Oral and Craniomaxillofacial Surgery, University Hospital of Basel.,5Department of Clinical Research, University of Basel, Switzerland
| | - Christoph Kunz
- 2Oral and Craniomaxillofacial Surgery, University Hospital of Basel.,4Faculty of Medicine and
| | - Raphael Guzman
- Departments of1Neurosurgery and.,3Division of Pediatric Neurosurgery, University Children's Hospital of Basel; and.,4Faculty of Medicine and
| | - Jehuda Soleman
- Departments of1Neurosurgery and.,3Division of Pediatric Neurosurgery, University Children's Hospital of Basel; and.,4Faculty of Medicine and
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Ishisaka E, Usami K, Kiyotani C, Terashima K, Ogiwara H. Neoadjuvant chemotherapy for atypical teratoid rhabdoid tumors (AT/RTs). Childs Nerv Syst 2020; 36:721-727. [PMID: 31745641 DOI: 10.1007/s00381-019-04422-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 10/25/2019] [Indexed: 11/26/2022]
Abstract
PURPOSE Atypical teratoid rhabdoid tumor (AT/RT) is a rare, clinically highly malignant tumor. The extent of the surgical resection may affect survival. However, it is often difficult to perform gross total resection (GTR) at an initial surgery because of the large tumor size and high vascularity. Neoadjuvant chemotherapy may reduce not only the size but also the vascularity. We report our experience, review the literature, and analyze its effectiveness. METHODS A retrospective chart review of patients who underwent neoadjuvant chemotherapy and second-look surgery was performed. Demographic data, treatment courses, changes in tumor after the chemotherapy, extent of resection and estimated blood loss (EBL) during the second-look surgery, and outcome of each children were evaluated. RESULTS There are 4 cases. The average age at diagnosis was 13.3 months (2-30 months). Two to 4 courses of neoadjuvant chemotherapy were performed. MRI after the chemotherapy showed reduction of tumor volume, and tumor vascularity at the second-look surgery decreased in all cases. GTR was achieved in 3 cases, and NTR in 1 case. The mean EBL/estimated blood volume (EBL/EBV) was 21.3% (1.5-39%). The mean follow-up period was 23 months (2-48 months). At the last follow-up, 2 patients were alive without recurrence of the tumor (the follow-up periods were 48 and 16 months). CONCLUSIONS Neoadjuvant chemotherapy for AT/RTs might reduce both tumor size and vascularity, which enabled the maximal tumor resection. It may contribute to improve the prognosis of AT/RT through facilitating the tumor resection.
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Affiliation(s)
- Eitaro Ishisaka
- Division of Neurosurgery, National Center for Child Health and Development, Tokyo, Japan
| | - Kenichi Usami
- Division of Neurosurgery, National Center for Child Health and Development, Tokyo, Japan
| | - Chikako Kiyotani
- Division of Neuro-Oncology, National Center for Child Health and Development, Tokyo, Japan
| | - Keita Terashima
- Division of Neuro-Oncology, National Center for Child Health and Development, Tokyo, Japan
| | - Hideki Ogiwara
- Division of Neurosurgery, National Center for Child Health and Development, Tokyo, Japan.
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11
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Hosmann A, Hinker F, Dorfer C, Slavc I, Haberler C, Dieckmann K, Knosp E, Czech T. Management of choroid plexus tumors-an institutional experience. Acta Neurochir (Wien) 2019; 161:745-754. [PMID: 30783805 PMCID: PMC6431303 DOI: 10.1007/s00701-019-03832-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 01/31/2019] [Indexed: 12/13/2022]
Abstract
Background Choroid plexus tumors are rare entities. Resection is the mainstay of treatment in grade I and grade II tumors and adjuvant treatment is usually reserved for the less frequent choroid plexus carcinoma (CPC). Outcome is not only related to their histological grade but also dependent on their size, location, and presence of often multifactorial disturbances of cerebrospinal fluid (CSF) circulation. Methods Retrospective analysis of 36 consecutive patients operated on a choroid plexus tumor at our institution in a mixed pediatric and adult population between 1991 and 2016. Results Twenty-one CPP, 11 atypical choroid plexus papillomas (aCPP), and four CPC were encountered in 17 children and 19 adults. Regardless of histological grading, gross-total resection (GTR) could be achieved in 91.7% of patients. Tumor recurrence (25.0%) was significantly associated with histological grading (p = 0.004), subtotal resection (p = 0.002), and intraoperatively evident zones of tumor infiltration (p = 0.001). Adjuvant therapy was performed in 19.4% of patients, mainly diagnosed with CPC. The 5-year overall survival rate was 95.2% for CPP and 100.0% for both aCPP and CPC. Survival was related to the extent of resection (p = 0.001), tumor progression (p = 0.04), and the presence of leptomeningeal metastases (p = 0.002). Even after resection, either ventricular or subdural shunting was required in 25.0% of patients. Conclusions We could confirm that GTR is crucial for treatment of choroid plexus tumors. Parenchymal tumor infiltration as detected intraoperatively was associated with the extent of resection and not limited to CPC. CSF disturbances mandating treatment may persist after resection.
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Affiliation(s)
- Arthur Hosmann
- Department of Neurosurgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
- Comprehensive Cancer Center-Central Nervous System Tumors Unit (CCC-CNS), Medical University of Vienna, Vienna, Austria
| | - Felix Hinker
- Department of Neurosurgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Christian Dorfer
- Department of Neurosurgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
- Comprehensive Cancer Center-Central Nervous System Tumors Unit (CCC-CNS), Medical University of Vienna, Vienna, Austria
| | - Irene Slavc
- Comprehensive Cancer Center-Central Nervous System Tumors Unit (CCC-CNS), Medical University of Vienna, Vienna, Austria
- Department of Pediatrics and Adolescence Medicine, Medical University of Vienna, Vienna, Austria
| | - Christine Haberler
- Comprehensive Cancer Center-Central Nervous System Tumors Unit (CCC-CNS), Medical University of Vienna, Vienna, Austria
- Institute of Neurology, Medical University of Vienna, Vienna, Austria
| | - Karin Dieckmann
- Comprehensive Cancer Center-Central Nervous System Tumors Unit (CCC-CNS), Medical University of Vienna, Vienna, Austria
- Department of Radiotherapy, Medical University of Vienna, Vienna, Austria
| | - Engelbert Knosp
- Department of Neurosurgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
- Comprehensive Cancer Center-Central Nervous System Tumors Unit (CCC-CNS), Medical University of Vienna, Vienna, Austria
| | - Thomas Czech
- Department of Neurosurgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
- Comprehensive Cancer Center-Central Nervous System Tumors Unit (CCC-CNS), Medical University of Vienna, Vienna, Austria.
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Krishnatry R. Challenges in the management of intraventricular tumors in the current era. CANCER RESEARCH, STATISTICS, AND TREATMENT 2019. [DOI: 10.4103/crst.crst_39_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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13
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Dash C, Moorthy S, Garg K, Singh PK, Kumar A, Gurjar H, Chandra PS, Kale SS. Management of Choroid Plexus Tumors in Infants and Young Children Up to 4 Years of Age: An Institutional Experience. World Neurosurg 2019; 121:e237-e245. [DOI: 10.1016/j.wneu.2018.09.089] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Revised: 09/10/2018] [Accepted: 09/12/2018] [Indexed: 11/17/2022]
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14
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Zaky W, Finlay JL. Pediatric choroid plexus carcinoma: Biologically and clinically in need of new perspectives. Pediatr Blood Cancer 2018. [PMID: 29528196 DOI: 10.1002/pbc.27031] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Choroid plexus (CP) carcinoma is a rare pediatric brain neoplasm. Recent studies have highlighted the potential of genome-wide methylation and gene expression profiling to provide additional layers of information to improve tumor risk-stratification. There is a lack of data regarding the best therapy, and approaches have been heterogeneous. Despite multidisciplinary treatment approaches, the outcome remains guarded and treatments have been based on case series and expert opinions. In this study, we discuss the recent wealth of data regarding CP carcinoma molecular biology and current management. We also briefly highlight the remaining barriers to formulate the best treatment strategies, and future therapeutic potentials.
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Affiliation(s)
- Wafik Zaky
- The Department of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jonathan L Finlay
- Division of Hematology, Oncology, and BMT, Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio
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15
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Kitahara T, Tsuji Y, Shirase T, Yukawa H, Takeichi Y, Yamazoe N. Neoadjuvant Chemotherapy for Facilitating Surgical Resection of Infantile Massive Intracranial Immature Teratoma. TOHOKU J EXP MED 2017; 238:273-8. [PMID: 27039944 DOI: 10.1620/tjem.238.273] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Immature teratoma (IMT) is the most frequent histological subtype of infantile intracranial teratoma, the most common congenital brain tumor. IMT contains incompletely differentiated components resembling fetal tissues. Infantile intracranial IMT has a dismal prognosis, because it is often inoperable due to its massive size and high vascularity. Neoadjuvant chemotherapy has been shown to be effective in decreasing tumor volume and vascularity to facilitate surgical resection in other types of infantile brain tumors. However, only one recent case report described the effectiveness of neoadjuvant chemotherapy for infantile intracranial IMT in the literature, even though it is common entity with a poor prognosis in infants. Here, we describe the case of a 2-month-old male infant with a very large intracranial IMT. Maximal surgical resection was first attempted but was unsuccessful because of severe intraoperative hemorrhage. Neoadjuvant carboplatin and etoposide (CARE) chemotherapy was then administered with the aim of shrinking and devascularizing the tumor. After neoadjuvant chemotherapy, tumor size did not decrease, but intraoperative blood loss significantly decreased and near-total resection was achieved by the second and third surgery. The patient underwent adjuvant CARE chemotherapy and has been alive for 3 years after surgery without tumor regrowth. Even when neoadjuvant chemotherapy does not decrease tumor volume of infantile intracranial IMT, surgical resection should be tried because chemotherapy can facilitate surgical resection and improve clinical outcome by reducing tumor vascularity.
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16
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Thatikunta M, Mutchnick I, Elster J, Thompson MP, Huang MA, Spalding AC, Moriarty T. Neoadjuvant chemotherapy for atypical teratoid rhabdoid tumors: case report. J Neurosurg Pediatr 2017; 19:546-552. [PMID: 28291373 DOI: 10.3171/2016.12.peds16427] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Atypical teratoid rhabdoid tumors (ATRTs) are a rare pediatric brain tumor with high mortality rate. Several large series have reported achieving gross-total resection (GTR) in less than 50% of patients due to the lesions' large size, vascularity, and limited blood volume in young patients. While neoadjuvant chemotherapy for choroid plexus carcinomas in pediatric patients has become widely accepted, it has not been used as widely for other pediatric brain tumors. To the best of the authors' knowledge, there are only 3 published cases of neoadjuvant chemotherapy for ATRTs. In the present report, the authors present a fourth case of neoadjuvant chemotherapy for ATRT and review the available literature on this strategy. A 17-month-old child presented with a left ventricular ATRT for which imaging raised concern for a highly vascularized tumor. The authors undertook neoadjuvant chemotherapy with 2 cycles of Head Start II therapy, which reduced the size of the ventricular tumor by 35% and decreased the vascularity of the lesion on imaging. The estimated blood loss during resection was 425 ml and GTR was achieved. The patient continued with postoperative chemotherapy but suffered an on-therapy recurrence. While higher-quality data are necessary, available evidence suggests that neoadjuvant chemotherapy can reduce the size and vascularity of ATRTs and facilitate a surgical avenue for large or "inoperable" tumors.
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Affiliation(s)
- Meena Thatikunta
- Department of Neurosurgery, University of Louisville School of Medicine
| | - Ian Mutchnick
- Department of Neurosurgery, University of Louisville School of Medicine.,Pediatric Neurosurgery, Norton Children's Hospital.,Norton Neuroscience Institute, Louisville, Kentucky
| | - Jennifer Elster
- Pediatric Hematology/Oncology, UC San Diego School of Medicine.,Rady Children's Hospital-San Diego, California
| | - Matthew P Thompson
- Pediatric and Perinatal Pathology Associates, Norton Children's Hospital
| | - Michael A Huang
- Pediatric Cancer & Blood Disorders, University of Louisville School of Medicine; and
| | - Aaron C Spalding
- Radiation Oncology, Norton Cancer Institute, Norton Healthcare, Louisville, Kentucky
| | - Thomas Moriarty
- Department of Neurosurgery, University of Louisville School of Medicine.,Pediatric Neurosurgery, Norton Children's Hospital.,Norton Neuroscience Institute, Louisville, Kentucky
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Bahar M, Hashem H, Tekautz T, Worley S, Tang A, de Blank P, Wolff J. Choroid plexus tumors in adult and pediatric populations: the Cleveland Clinic and University Hospitals experience. J Neurooncol 2017; 132:427-432. [DOI: 10.1007/s11060-017-2384-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Accepted: 02/23/2017] [Indexed: 11/24/2022]
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18
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Soleman J, Schneider CA, Pfeifle VA, Zimmermann P, Guzman R. Laparoscopic-Assisted Ventriculoperitoneal Shunt Placement in Children Younger Than the Age of 1 Year. World Neurosurg 2016; 99:656-661. [PMID: 28034817 DOI: 10.1016/j.wneu.2016.12.075] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2016] [Revised: 12/17/2016] [Accepted: 12/18/2016] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To analyze the safety and feasibility of laparoscopic-assisted ventriculoperitoneal shunt (VPS) insertion in children younger than the age of 1 year and weighing less than 5 kg. METHODS We performed a retrospective review of children receiving laparoscopic-assisted VPS. Patient characteristics, complications, operation and hospitalization time, blood loss, and conversion to the standard approach were noted and analyzed. RESULTS Laparoscopic-assisted VPS was performed in 25 children. Mean age was 32 months (range 19 days to 18 years); 16 patients (64%) were younger than the age of 1 year and 10 patients (38%) weighed less than 5 kg at the time of surgery. In all cases laparoscopic insertion was possible without the need to convert to the standard approach. No intraoperative laparoscopy-associated complications occurred. Mean estimated blood volume lost was 4.52%, showing no significant difference between patients younger and older than 1 year. Mean operation time was 75.44 minutes (range 45-121 minutes), and mean hospitalization time was 37.1 days (range 4-142 days, median: 22 days). Patients younger than the age of 1 year showed significant shorter operation time (P < 0.001) and longer hospitalization time (P = 0.04). Complication rate within 30 days was 24% (n = 6), and overall complication rate was 36% (n = 9), whereas none were related to the abdominal placement of the catheter, and showed no difference between the 2 age groups. CONCLUSIONS Laparoscopic-assisted VPS insertion in children seems to be safe and feasible leading to very good results even in patients under the age of 1 and weighing less than 5 kg.
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Affiliation(s)
- Jehuda Soleman
- Department of Pediatric Neurosurgery, University Children's Hospital of Basel, Basel, Switzerland.
| | - Christian A Schneider
- Department of Pediatric Neurosurgery, University Children's Hospital of Basel, Basel, Switzerland
| | - Viktoria A Pfeifle
- Department of Pediatric Surgery, University Children's Hospital of Basel, Basel, Switzerland
| | - Peter Zimmermann
- Department of Pediatric Surgery, University Children's Hospital of Basel, Basel, Switzerland
| | - Raphael Guzman
- Department of Pediatric Neurosurgery, University Children's Hospital of Basel, Basel, Switzerland
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