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Ichinose T, Hayashi Y, Sasagawa Y, Oishi M, Higashi R, Nakada M. A case of rapid deterioration in a subacute period after endoscopic third ventriculostomy. Br J Neurosurg 2024; 38:447-450. [PMID: 33605824 DOI: 10.1080/02688697.2021.1885624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 01/28/2021] [Indexed: 10/22/2022]
Abstract
Background: Although generally a safe procedure, serious postoperative complications after endoscopic third ventriculostomy (ETV) for obstructive hydrocephaly have been rarely reported, such as delayed obstruction of the stoma at the third ventricle floor.Case description: A 20-year-old male was referred to our department because of severe headache and diplopia. A pineal tumour and obstructive hydrocephaly were detected in preoperative imaging. After tumour biopsy and ETV, the reduction of ventricle size and improvement of headaches were immediately observed. On the seventh day, however, he developed a rapidly progressing consciousness disturbance due to severe hydrocephalus leading to urgent secondary ETV. The original ventriculostomy stoma at the third ventricle floor was completely occluded by scar adhesion. The patient recovered well as previously and received additional treatment.Conclusion: Although very rare, occlusion of the ventriculostomy stoma can postoperatively occur in the subacute period. Patients undergoing ETV for obstructive hydrocephalus due to a pineal tumour should be carefully monitored to avoid serious consequences.
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Affiliation(s)
- Toshiya Ichinose
- Department of Neurosurgery, Kanazawa University, Graduate School of Medical Science, Kanazawa, Japan
| | - Yasuhiko Hayashi
- Department of Neurosurgery, Kanazawa University, Graduate School of Medical Science, Kanazawa, Japan
- Department of Neurosurgery, Kanazawa Medical University, Kahoku, Japan
| | - Yasuo Sasagawa
- Department of Neurosurgery, Kanazawa University, Graduate School of Medical Science, Kanazawa, Japan
| | - Masahiro Oishi
- Department of Neurosurgery, Kanazawa University, Graduate School of Medical Science, Kanazawa, Japan
| | - Ryo Higashi
- Department of Neurosurgery, Higashi Hospital, Komatsu, Japan
| | - Mitsutoshi Nakada
- Department of Neurosurgery, Kanazawa University, Graduate School of Medical Science, Kanazawa, Japan
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Arzumanov G, Jeong SW, Gupta B, Dabecco R, Sandoval J, Shepard MJ, Leonardo J, Yu A. Occipital-interhemispheric transtentorial pineal mass resection. Neurosurg Focus Video 2024; 10:V16. [PMID: 38283813 PMCID: PMC10821640 DOI: 10.3171/2023.10.focvid23161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 10/20/2023] [Indexed: 01/30/2024]
Abstract
The occipital approach for pineal tumors was first described by James Poppen in 1966. Since then, it has been widely used for accessing deep-seated tumors as it offers a wider surgical view than the supracerebellar transtentorial approach. This video demonstrates the technical nuances of the occipital transtentorial approach and the exoscopic dissection of a pineal gland tumor in a 66-year-old male. Use of the exoscope over the microscope provides certain ergonomic advantages and improves surgical workflow, as demonstrated here. The video can be found here: https://stream.cadmore.media/r10.3171/2023.10.FOCVID23161.
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Affiliation(s)
- Grant Arzumanov
- Department of Neurosurgery, Allegheny General Hospital, Pittsburgh, Pennsylvania
| | - Seung W Jeong
- Department of Neurosurgery, Allegheny General Hospital, Pittsburgh, Pennsylvania
| | - Bhavika Gupta
- Department of Neurosurgery, Allegheny General Hospital, Pittsburgh, Pennsylvania
| | - Rocco Dabecco
- Department of Neurosurgery, Allegheny General Hospital, Pittsburgh, Pennsylvania
| | - Jose Sandoval
- Department of Neurosurgery, Allegheny General Hospital, Pittsburgh, Pennsylvania
| | - Matthew J Shepard
- Department of Neurosurgery, Allegheny General Hospital, Pittsburgh, Pennsylvania
| | - Jody Leonardo
- Department of Neurosurgery, Allegheny General Hospital, Pittsburgh, Pennsylvania
| | - Alexander Yu
- Department of Neurosurgery, Allegheny General Hospital, Pittsburgh, Pennsylvania
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3
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Cavalheiro S, Valsechi LC, Dastoli PA, Nicácio JM, Cappellano AM, Saba da Silva N, Silva da Costa MD. Outcomes and surgical approaches for pineal region tumors in children: 30 years' experience. J Neurosurg Pediatr 2023:1-10. [PMID: 37148224 DOI: 10.3171/2023.3.peds22468] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 03/29/2023] [Indexed: 05/08/2023]
Abstract
OBJECTIVE Pineal region tumors account for 2.7%-11% of all CNS tumors in children. In this series, the authors present their surgical results and long-term outcomes from a pediatric pineal region tumor cohort. METHODS A total of 151 children aged 0-18 years were treated from 1991 to 2020. Tumor markers were collected in all patients; if positive, chemotherapy was performed, and if negative, biopsy was performed, preferably endoscopically. Resection was performed when there was a residual germ cell tumor (GCT) lesion after chemotherapy. RESULTS The distribution based on histological type, as verified by markers, biopsy, or surgery, was germinoma (33.1%), nongerminomatous GCT (NGGCT) (27.2%), pineoblastoma (22.5%), glioma (12.6%), and embryonal tumor (atypical teratoid rhabdoid tumor) (3.3%). A total of 97 patients underwent resection, and gross-total resection (GTR) was achieved in 64%; the highest GTR rate (76.6%) was found in patients with GCTs, and the lowest (30.8%) was found in those with gliomas. The supracerebellar infratentorial approach (SCITA) was the most common, performed in 53.6% of patients, followed by the occipital transtentorial approach (OTA), performed in 24.7% of patients. Lesions were biopsied in 70 patients, and the diagnostic accuracy was 91.4. The overall survival (OS) rates at 12, 24, and 60 months as stratified by histological type were 93.7%, 93.7%, and 88% for patients with germinomas; 84.5%, 63.5%, and 40.7% for patients with pineoblastomas; 89.4%, 80.8%, and 67.2% for patients with NGGCTs; 89.4%, 78.2%, and 72.6% for patients with gliomas; and 40%, 20%, and 0% for patients with embryonal tumors, respectively (p < 0001). The OS at 60 months was significantly higher in the group with GTR (69.7%) than in the group with subtotal resection (40.8%) (p = 0.04). The 5-year progression-free survival was 77% for patients with germinomas, 72.6% for patients with gliomas, 50.8% for patients with NGGCTs, and 38.9% for patients with pineoblastomas. CONCLUSIONS The efficacy of resection varies by histological type, and complete resection is associated with higher OS rates. Endoscopic biopsy is the method of choice for patients presenting with negative tumor markers and hydrocephalus. For tumors restricted to the midline and with extension to the third ventricle, a SCITA is preferred, whereas for lesions with extension toward the fourth ventricle, an OTA is preferred.
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Affiliation(s)
- Sergio Cavalheiro
- 1Department of Neurology and Neurosurgery, Federal University of São Paulo
- 2Division of Neurosurgery, Institute of Pediatric Oncology (IOP/GRAACC); and
| | | | - Patricia Alessandra Dastoli
- 1Department of Neurology and Neurosurgery, Federal University of São Paulo
- 2Division of Neurosurgery, Institute of Pediatric Oncology (IOP/GRAACC); and
| | - Jardel Mendonça Nicácio
- 1Department of Neurology and Neurosurgery, Federal University of São Paulo
- 2Division of Neurosurgery, Institute of Pediatric Oncology (IOP/GRAACC); and
| | - Andrea Maria Cappellano
- 3Division of Neuro-Oncology, Institute of Pediatric Oncology (IOP/GRAACC), São Paulo, Brazil
| | - Nasjla Saba da Silva
- 3Division of Neuro-Oncology, Institute of Pediatric Oncology (IOP/GRAACC), São Paulo, Brazil
| | - Marcos Devanir Silva da Costa
- 1Department of Neurology and Neurosurgery, Federal University of São Paulo
- 2Division of Neurosurgery, Institute of Pediatric Oncology (IOP/GRAACC); and
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4
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Kato H, Tanei T, Nishimura Y, Nagashima Y, Ishii M, Nishii T, Fukaya N, Abe T, Saito R. Pineal parenchymal tumor of intermediate differentiation with late spinal dissemination 13 years after initial surgery: illustrative case. J Neurosurg Case Lessons 2023; 5:CASE22475. [PMID: 36794736 PMCID: PMC10550595 DOI: 10.3171/case22475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 12/12/2022] [Indexed: 02/16/2023]
Abstract
BACKGROUND Pineal parenchymal tumors of intermediate differentiation (PPTIDs) are rare in the pineal gland. A case of PPTID that disseminated to the lumbosacral spine 13 years after the total resection of a primary intracranial tumor has been reported. OBSERVATIONS A 14-year-old female presented with headache and diplopia. Magnetic resonance imaging revealed a pineal tumor that induced obstructive hydrocephalus. A biopsy and endoscopic third ventriculostomy were performed. Histological diagnosis revealed a grade II PPTID. Two months later, the tumor was removed via craniotomy because the postoperative Gamma Knife surgery was ineffective. Histological diagnosis confirmed PPTID, although the grade was revised from II to III. Postoperative adjuvant therapy was not performed, because the lesion had been irradiated and gross total tumor removal was achieved. She has had no recurrence in 13 years. However, pain around the anus newly appeared. Magnetic resonance imaging of the spine revealed a solid lesion in the lumbosacral spine. The lesion was subtotally resected, and histological diagnosis revealed grade III PPTID. Postoperative radiotherapy was performed, and she had no recurrence 1 year after radiotherapy. LESSONS Remote dissemination of PPTID can occur several years after the initial resection. Regular follow-up imaging, including the spinal region, should be encouraged.
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Mobark NA, Alharbi M, Alotabi F, Alshoumer A, Al Shakweer W, AlNaqib ZG, AlSaad AN, Balbaid AO, Alsolme E, Abedalthagafi MS. Papillary Tumor of the Pineal Region Rare Pediatric CNS Tumor Case Series Treated in King Fahad Medical City (KFMC). Curr Oncol 2022; 29:7558-7568. [PMID: 36290872 PMCID: PMC9600283 DOI: 10.3390/curroncol29100595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 09/26/2022] [Accepted: 10/09/2022] [Indexed: 11/05/2022] Open
Abstract
The clinical behaviors, prognosis, and appropriate treatments of papillary tumors of the pineal region (PTPR) are not fully defined due to the rarity of these tumors. At diagnosis, PTPR may present with clinical symptoms, including headache with obstructive hydrocephalus, diplopia, vomiting, and lethargy, as well as neurological signs, including Argyll Robertson pupils and Parinaud's syndrome due to compression of the dorsal midbrain, specifically the periaqueductal region with horizontal nystagmus. Radiological assessment of pineal region lesions is challenging, with a wide range of potential differential diagnoses. PTPR typically presents as a heterogeneous, well-circumscribed mass in the pineal region, which might contain cystic areas, calcifications, hemorrhages, or protein accumulations. Here, we report three female pediatric patients with PTPR treated in King Fahad Medical City (KFMC) in Saudi Arabia. Histological and immunohistochemical diagnosis was confirmed by analysis of genome-wide DNA methylation profiles. This case series expands on the available reports on the clinical presentations of PTPR and provides important information on the responses to different treatment modalities.
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Affiliation(s)
- Nahla A. Mobark
- Department of Pediatric Oncology Comprehensive Cancer Centre, King Fahad Medical City, Riyadh 12231, Saudi Arabia
| | - Musa Alharbi
- Department of Pediatric Oncology Comprehensive Cancer Centre, King Fahad Medical City, Riyadh 12231, Saudi Arabia
| | - Fahad Alotabi
- Pediatric Neurosurgical Department, King Fahad Medical City, Riyadh 12231, Saudi Arabia
| | - Azhar Alshoumer
- Department of Pathology & Laboratory Medicine, King Fahad Medical City, Riyadh 12231, Saudi Arabia
| | - Wafa Al Shakweer
- Department of Pathology & Laboratory Medicine, King Fahad Medical City, Riyadh 12231, Saudi Arabia
| | - Zaid G. AlNaqib
- Department of Pediatric Oncology Comprehensive Cancer Centre, King Fahad Medical City, Riyadh 12231, Saudi Arabia
| | | | - Ali O. Balbaid
- Radiation Oncology Department, Comprehensive Cancer Centre, King Fahad Medical City, Riyadh 12231, Saudi Arabia
| | - Ebtehal Alsolme
- Genomics Research Department, King Fahad Medical City, Riyadh 12231, Saudi Arabia
| | - Malak S. Abedalthagafi
- Genomics Research Department, King Fahad Medical City, Riyadh 12231, Saudi Arabia
- Department of Pathology & Laboratory Medicine, Emory University, Atlanta, GA 30322, USA
- Correspondence:
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Donoho DA, Aldave G. Interhemispheric transcallosal intervenous approach to a pineal region tumor. Neurosurg Focus Video 2021; 5:V11. [PMID: 36284903 PMCID: PMC9549995 DOI: 10.3171/2021.4.focvid2120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 04/14/2021] [Indexed: 06/16/2023]
Abstract
Pineal region tumors represent a formidable challenge to the neurosurgeon. Choosing the right approach is key to optimizing the extent of resection and minimizing surgical morbidity. In this video, the authors show an interhemispheric transcallosal approach to a pineal region tumor in a 15-year-old boy. The advantage of this corridor over posterior approaches is that it provides a nice view of the tumor plane with the venous complex, especially while dissecting tumor from the anterior aspect of the internal cerebral veins on their vertical path. Thus, this approach represents a safe and effective alternative for selected pineal tumors. The video can be found here: https://stream.cadmore.media/r10.3171/2021.4.FOCVID2120.
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Affiliation(s)
- Daniel A. Donoho
- Division of Neurosurgery, Department of Surgery, Texas Children’s Hospital, Houston; and
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
| | - Guillermo Aldave
- Division of Neurosurgery, Department of Surgery, Texas Children’s Hospital, Houston; and
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
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7
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Torres AR, Salvador C, Mora MD, Chavez W, Romero J. Pineal Dysgerminoma: A Misleading Clinical Course With Potential Life-Threatening Consequences. Cureus 2020; 12:e9365. [PMID: 32850234 PMCID: PMC7444959 DOI: 10.7759/cureus.9365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Pineal dysgerminomas are sporadic pediatric intracranial tumors that usually grow as midline lesions around the third ventricle, most frequently the pineal gland and the pituitary regions of the brain. The severity of symptoms is dependent on the location of the lesion and can present with increased intracranial symptoms. We report a 20-year-old man who presented with new-onset headaches over the past month that would wake him from his sleep at night. The headaches, however, resolved completely one week prior to his first neurological evaluation. A thorough neurological examination was normal. A careful review of the literature does not show a case of a pineal tumor presenting with spontaneous regression of intracranial pressure, and therefore we would like to raise awareness among clinicians about this potential course. A delay in obtaining imaging could have been life-threatening; thus, we recommend a high index of suspicion when patients present with recent symptoms suggesting increased intracranial pressure. Our patient had an excellent outcome two years after his presentation, with appropriate management including drainage of the cerebrospinal fluid, chemotherapy, and radiotherapy.
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Affiliation(s)
- Alcy R Torres
- Pediatrics, Boston University School of Medicine, Boston, USA
| | - Carla Salvador
- Pediatrics, Boston University School of Medicine, Boston, USA
| | - Mauricio D Mora
- Pediatrics, Boston University School of Medicine, Boston, USA
| | - Wilson Chavez
- Pediatrics Neurology, Boston Medical Center, Boston, USA
| | - Javier Romero
- Neuroradiology, Massachusetts General Hospital, Boston, USA
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8
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Campos LA, Bueno C, Barcelos IP, Halpern B, Brito LC, Amaral FG, Baltatu OC, Cipolla-Neto J. Melatonin Therapy Improves Cardiac Autonomic Modulation in Pinealectomized Patients. Front Endocrinol (Lausanne) 2020; 11:239. [PMID: 32431667 PMCID: PMC7213221 DOI: 10.3389/fendo.2020.00239] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Accepted: 04/01/2020] [Indexed: 12/20/2022] Open
Abstract
The purpose of this investigational study was to assess the effects of melatonin replacement therapy on cardiac autonomic modulation in pinealectomized patients. This was an open-label, single-arm, single-center, proof-of-concept study consisting of a screening period, a 3-month treatment period with melatonin (3 mg/day), and a 6-month washout period. The cardiac autonomic function was determined through heart rate variability (HRV) measures during polysomnography. Pinealectomized patients (n = 5) with confirmed absence of melatonin were included in this study. Melatonin treatment increased vagal-dominated HRV indices including root mean square of the successive R-R interval differences (RMSSD) (39.7 ms, 95% CI 2.0-77.4, p = 0.04), percentage of successive R-R intervals that differ by more than 50 ms (pNN50) (17.1%, 95% CI 9.1-25.1, p = 0.003), absolute power of the high-frequency band (HF power) (1,390 ms2, 95% CI 511.9-2,267, p = 0.01), and sympathetic HRV indices like standard deviation of normal R-R wave interval (SDNN) (57.6 ms, 95% CI 15.2-100.0, p = 0.02), and absolute power of the low-frequency band (LF power) (4,592 ms2, 95% CI 895.6-8,288, p = 0.03). These HRV indices returned to pretreatment values when melatonin treatment was discontinued. The HRV entropy-based regularity parameters were not altered in this study, suggesting that there were no significant alterations of the REM-NREM ratios between the time stages of the study. These data show that 3 months of melatonin treatment may induce an improvement in cardiac autonomic modulation in melatonin-non-proficient patients. ClinicalTrials.gov Identifier: NCT03885258.
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Affiliation(s)
- Luciana Aparecida Campos
- Center of Innovation, Technology and Education (CITE) at São José dos Campos Technology Park, São Paulo, Brazil
- Institute of Biomedical Engineering, Anhembi Morumbi University, Laureate International Universities, São José dos Campos, Brazil
- College of Health Sciences, Abu Dhabi University, Abu Dhabi, United Arab Emirates
| | - Clarissa Bueno
- Department of Physiology and Biophysics, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
- Department of Pediatric Neurology, Hospital das Clínicas of University of São Paulo Medical School, São Paulo, Brazil
| | - Isabella P. Barcelos
- Department of Physiology and Biophysics, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - Bruno Halpern
- Department of Endocrinology and Metabolism, Hospital das Clínicas of University of São Paulo Medical School, São Paulo, Brazil
| | - Leandro C. Brito
- Exercise Hemodynamic Laboratory, School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil
| | - Fernanda G. Amaral
- Department of Physiology, Federal University of São Paulo, São Paulo, Brazil
| | - Ovidiu Constantin Baltatu
- Center of Innovation, Technology and Education (CITE) at São José dos Campos Technology Park, São Paulo, Brazil
- Institute of Biomedical Engineering, Anhembi Morumbi University, Laureate International Universities, São José dos Campos, Brazil
- Department of Pharmacology and Therapeutics, College of Medicine & Health Sciences, Khalifa University, Abu Dhabi, United Arab Emirates
- *Correspondence: Ovidiu Constantin Baltatu
| | - José Cipolla-Neto
- Department of Physiology and Biophysics, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
- José Cipolla-Neto
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Ahmed SI, Javed G, Laghari AA, Bareeqa SB, Aziz K, Khan M, Samar SS, Humera RA, Khan AR, Farooqui MO, Shahbaz A. Third Ventricular Tumors: A Comprehensive Literature Review. Cureus 2018; 10:e3417. [PMID: 30542631 PMCID: PMC6284874 DOI: 10.7759/cureus.3417] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Third ventricle tumors are uncommon and account for 0.6 - 0.9% of all the brain tumors. Tumors of the third ventricle are classified into primary tumors, such as colloid cysts, choroid plexus papillomas, and ependymomas, or secondary tumors, such as craniopharyngiomas, optic nerve gliomas, pineal tumors, and meningiomas. Third ventricular tumors are uncommon, and their treatment involves significant morbidity and mortality. The colloid cyst has a better surgical outcome and many approaches are available to achieve a complete cure. Choroid plexus papilloma is also a common tumor documented with its treatment majorly based on surgical resection. In addition to multiple treatment options for craniopharyngiomas, surgery is the most preferred treatment option. Ependymomas also have few treatment options, with surgical resection adopted as the first line of treatment.
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Affiliation(s)
- Syed Ijlal Ahmed
- Neurosurgery, Liaquat National Hospital and Medical College, Karachi, PAK
| | - Gohar Javed
- Neurosurgery, The Aga Khan University, Karachi, PAK
| | | | | | - Kashif Aziz
- Internal Medicine, Icahn School of Medicine at Mount Sinai/Queens Hospital Center, New York, USA
| | - Mehreen Khan
- Internal Medicine, The George Washington University School of Medicine and Health Sciences, Washington DC, USA
| | - Syeda Sana Samar
- Internal Medicine, Jinnah Sindh Medical University, Karachi , PAK
| | | | - Alizay Rashid Khan
- Internal Medicine, Dow University of Health Sciences (DUHS), Karachi, PAK
| | | | - Amir Shahbaz
- Internal Medicine, Icahn School of Medicine at Mount Sinai/Queens Hospital Center, New York, USA
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Nagm A, Ogiwara T, Goto T, Chiba A, Hongo K. Neuroendoscopy via an Extremely Narrow Foramen of Monro: A Case Report. NMC Case Rep J 2016; 4:37-42. [PMID: 28664024 PMCID: PMC5364906 DOI: 10.2176/nmccrj.cr.2016-0157] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 07/18/2016] [Indexed: 11/25/2022] Open
Abstract
Herein, safe and reliable neuroendoscopic biopsy via an extremely narrow foramen of Monro (ENFM) for a non-hydrocephalic patient with hypothalamic and pineal region tumors was successfully applied. A 17-year-old boy presented with hypothalamic manifestations attributed to hypothalamic and pineal region tumors. Small ventricles were seen. Intraoperatively, to advance different diameter steerable fiberscopes via ENFM, the third ventricle was flushed to induce a moment increase in the intraventricular pressure with subsequent dilatation of FM. Postoperative course was uneventful. Histopathological studies revealed a yolk sac tumor. Adjuvant therapy was applied. Follow-up neuroimaging disclosed marvellous improvement of the condition. His symptoms gradually improved.
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Affiliation(s)
- Alhusain Nagm
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan and.,Department of Neurosurgery, Al-Azhar University Faculty of Medicine-Nasr city, Cairo, Egypt
| | - Toshihiro Ogiwara
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan and
| | - Tetsuya Goto
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan and
| | - Akihiro Chiba
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan and
| | - Kazuhiro Hongo
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Japan and
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11
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Ishi Y, Yamaguchi S, Iguchi A, Cho Y, Ohshima J, Hatanaka KC, Takakuwa E, Kobayashi H, Terasaka S, Houkin K. Primary pineal rhabdomyosarcoma successfully treated by high-dose chemotherapy followed by autologous peripheral blood stem cell transplantation: case report. J Neurosurg Pediatr 2016; 18:41-5. [PMID: 26942266 DOI: 10.3171/2015.12.peds15419] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Primary intracranial rhabdomyosarcoma is quite rare, and its prognosis is poor compared with that for rhabdomyosarcoma in other organs. The authors present a case of pineal rhabdomyosarcoma successfully managed with multimodal therapy including surgery, chemotherapy, radiation, and high-dose chemotherapy (HDC) followed by autologous peripheral blood stem cell transplantation (HDC/APBSCT). An 8-year-old girl presenting with headache and nausea was referred to the authors' institution. Computed tomography and MRI revealed a pineal tumor associated with obstructive hydrocephalus. Subsequently, an emergent endoscopic tumor biopsy and third ventriculostomy were performed. The patient's symptoms immediately improved. The most likely pathological diagnosis was embryonal rhabdomyosarcoma. Chemotherapy with etoposide, cyclophosphamide, cisplatin, pirarubicin, ifosfamide, actinomycin D, and vincristine was followed by a second-look operation and whole-brain and craniospinal radiation. Because the intraoperative findings and pathological examination of the second operation suggested a definitive diagnosis of rhabdomyosarcoma and the presence of viable residual tumor cells, HDC with etoposide and melphalan was followed by APBSCT. The patient was discharged from the hospital without residual tumor or any neurological deficit. No recurrence was observed at 30 months. This is the first case of primary pineal rhabdomyosarcoma treated with HDC/APBSCT. Although the efficacy of HDC/APBSCT for rhabdomyosarcoma has not been established, the prognosis of primary intracranial rhabdomyosarcoma treated with conventional treatment is quite poor. High-dose chemotherapy followed by APBSCT may contribute to a better prognosis for primary intracranial rhabdomyosarcoma.
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Affiliation(s)
| | | | - Akihiro Iguchi
- Pediatrics, Hokkaido University Graduate School of Medicine and
| | - Yuko Cho
- Pediatrics, Hokkaido University Graduate School of Medicine and
| | - Junjiro Ohshima
- Pediatrics, Hokkaido University Graduate School of Medicine and
| | - Kanako C Hatanaka
- Department of Surgical Pathology, Hokkaido University Hospital, Sapporo, Hokkaido, Japan
| | - Emi Takakuwa
- Department of Surgical Pathology, Hokkaido University Hospital, Sapporo, Hokkaido, Japan
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12
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Abstract
Background: Pineal tumors are very uncommon intracranial lesions, and endodermal cysts in this location are extremely rare. Case Description: A 49-year-old right-handed female presented with 3 weeks history of progressive dizziness and imbalance. Imaging studies showed 1.8 cm × 1.7 cm × 1.8 cm pineal lesion with small enhancing mural component displacing ventrally the quadrigeminal plate and narrowing of aqueduct of Sylvius without hydrocephalus. In addition, she was found with small interhemispheric lipoma, and small posterior falx possible meningioma. Cerebrospinal fluid markers obtained by lumbar puncture were all negative. She underwent tumor resection, and final pathology reported endodermal cyst. No new deficits were encountered, and her gait imbalance improved significantly by 3 months follow-up. Conclusions: With evidence of enlargement or symptomatic pineal lesions, surgical consideration is necessary. Among pineal lesions, endodermal cysts are extremely uncommon and although benign pathology, long-term follow-up is advised due to unknown chronic behavior.
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Affiliation(s)
- Miguel Angel Lopez-Gonzalez
- Department of Neurosurgery, Arkansas Neurosciences Institute, CHI St Vincent Infirmary, Little Rock, AR 72205, USA
| | - Eugen Dolan
- Department of Neurosurgery, Billings Clinic, Billings, MT 59101, USA
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13
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Abstract
OBJECTIVE The ophthalmological outcomes of children treated for pineal tumors have received limited attention in the literature. METHODS This paper reviews the outcomes of 29 children treated for pineal and posterior third ventricular tumors in the contemporary era using chemotherapy, radiotherapy, and resection as defined by the histology and/or marker profile of the tumor. RESULTS At the time of diagnosis, all patients except 1 had hydrocephalus and all had ophthalmological involvement. Papilledema was found in 69% of patients. Seventy-five percent of patients had partial or complete Parinaud's syndrome, and diplopia or blurred vision was noted in the remaining patients. Visual acuity was impaired in 8 patients. Outcomes were dependent on the histology of the tumor and the treatment required. Those patients who did not requiring resection showed a lower rate of ophthalmological worsening during treatment and greater long-term improvement, in particular with respect to up-gaze palsy. Patients who underwent resection for postchemotherapy residual disease or primary resection showed greater worsening during treatment and lesser degrees of recovery. All patients with impaired visual acuity improved with treatment. CONCLUSIONS As the mortality of germ cell and other pineal tumors decreases, posttreatment morbidity remains, specifically that related to convergence nystagmus, accommodation, and diplopia. In addition to survival, ophthalmological morbidity should be reported in studies concerning the outcomes of treatment for pineal neoplasms.
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Affiliation(s)
| | | | - Juliette Hukin
- Pediatrics, University of British Columbia and British Columbia's Children's Hospital, Vancouver, British Columbia, Canada
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14
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Felbaum D, Syed HR, Ryan JE, Jean WC, Anaizi A. Endoscope-Assisted Combined Supracerebellar Infratentorial and Endoscopic Transventricular Approach to the Pineal Region: A Technical Note. Cureus 2016; 8:e520. [PMID: 27081581 PMCID: PMC4829397 DOI: 10.7759/cureus.520] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Neoplasms of the pineal region comprise less than 2% of all intracranial lesions. A variety of techniques have been adapted to gain access to the pineal region. Classic approaches employ the use of the microscope. More recently, the endoscope has been utilized to improve access to such deep-seated lesions. A 62-year-old female presented with a heterogeneously enhancing lesion in the pineal region with associated hydrocephalus. On exam, the patient exhibited Parinaud's syndrome. The patient initially underwent a single burr hole endoscopic third ventriculostomy and biopsy of the lesion. Initial pathology was consistent with a grade III astrocytoma. Following a period of recuperation, she returned for definitive surgical resection. A suboccipital craniectomy was performed in the sitting position. Prior to dural opening, an endoscope was inserted into the right lateral ventricle through the prior burr hole.The endoscope was passed through the foramen of Monro and the tumor could be visualized along the posterior third ventricle. The patient underwent a standard supracerebellar infratentorial approach aided by the microscope. After initial debulking of the pineal lesion, an endoscope was utilized to guide the depth of resection and assist in dissection with transventricular manipulation of the tumor. During the final stages of resection from the craniotomy, the endoscope was used to help visualize the posterior supracerebellar corridor. This assisted in the assessment of the extent of resection. The endoscope was also utilized for the removal of intraventricular blood products following tumor resection. The patient was extubated and transferred to the intensive care unit. A postoperative contrast-enhanced magnetic resonance imaging (MRI) revealed greater than 95% resection, with expected residual within the midbrain. The combined supracerebellar infratentorial and transventricular endoscope-assisted approach provided maximum visualization and aided in optimal resection of a traditionally difficult pineal region tumor. Further experience with this combined technique may allow for improved surgical outcomes for these complex lesions.
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Affiliation(s)
| | - Hasan R Syed
- Neurosurgery, Medstar Georgetown University Hospital
| | - Joshua E Ryan
- Neurosurgery, Medstar Georgetown University Hospital
| | - Walter C Jean
- Neurosurgery, Medstar Georgetown University Hospital
| | - Amjad Anaizi
- Neurosurgery, Medstar Georgetown University Hospital
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15
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Abstract
This video demonstrates surgical techniques of the occipital transtentorial approach to a pineal region tumor without using a fixed brain retractor, which may cause functional impairment or even tissue injury to the occipital visual cortex. There are several ways to facilitate retractorless surgery through this approach. A lateral-semiprone positioning of the patient can induce gravity retraction. The brain is relaxed by draining CSF fluid through lumbar drainage or lateral ventricular tap in the case of obstructive hydrocephalus. Dynamic retraction with handheld instruments after extensive dissection of the deep venous system, including basal veins, can provide a sufficient working space. The video can be found here: https://youtu.be/kQvEHiNcRow .
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Affiliation(s)
- Naoyuki Nakao
- Department of Neurological Surgery, Wakayama Medical University, Wakayama, Japan
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16
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Abstract
BACKGROUND Diffusion weighted imaging (DWI) has been shown to be helpful in characterizing tumor cellularity, and predicting histology. Several works have evaluated this technique for pineal tumors; however studies to date have not focused on pediatric pineal tumors. OBJECTIVE We evaluated the diffusion characteristics of pediatric pineal tumors to confirm if patterns seen in studies using mixed pediatric and adult populations remain valid. MATERIALS AND METHODS This retrospective study was performed after Institutional Review Board approval. We retrospectively evaluated all patients 18 years of age and younger with pineal tumors from a single institution where preoperative diffusion weighted imaging as well as histologic characterization was available. RESULTS Twenty patients (13 male, 7 female) with pineal tumors were identified: seven with pineoblastoma, four with Primitive Neuroectodermal Tumor (PNET), two with other pineal tumors, and seven with germ cell tumors including two germinomas, three teratomas, and one mixed germinoma-teratoma. The mean apparent diffusion coefficient (ADC) values in pineoblastoma (544 ± 65 × 10⁻⁶ mm²/s) and pineoblastoma/PNET (595 ± 144 × 10⁻⁶ mm²/s) was lower than that of the germ cell tumors (1284 ± 334 × 10⁻⁶ mm²/s; p < 0.0001 vs pineoblastoma). One highly cellular germinoma had an ADC value of 694 × 10⁻⁶ mm²/s. CONCLUSION ADC values can aid in differentiation of pineoblastoma/PNET from germ cell tumors in a population of children with pineal masses.
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Affiliation(s)
- Asim F Choudhri
- Department of Radiology, University of Tennessee Health Science Center, USA Department of Neurosurgery, University of Tennessee Health Science Center, USA Department of Ophthalmology, University of Tennessee Health Science Center, USA Le Bonheur Neuroscience Institute, Le Bonheur Children's Hospital, USA
| | - Matthew T Whitehead
- Department of Radiology, University of Tennessee Health Science Center, USA Le Bonheur Neuroscience Institute, Le Bonheur Children's Hospital, USA Department of Radiology, Children's National Medical Center, USA
| | - Adeel Siddiqui
- Department of Radiology, University of Tennessee Health Science Center, USA Le Bonheur Neuroscience Institute, Le Bonheur Children's Hospital, USA
| | - Paul Klimo
- Department of Neurosurgery, University of Tennessee Health Science Center, USA Le Bonheur Neuroscience Institute, Le Bonheur Children's Hospital, USA Semmes-Murphey Neurologic and Spine Institute, USA Division of Neurosurgery, St Jude Children's Hospital, USA
| | - Frederick A Boop
- Department of Neurosurgery, University of Tennessee Health Science Center, USA Le Bonheur Neuroscience Institute, Le Bonheur Children's Hospital, USA Semmes-Murphey Neurologic and Spine Institute, USA Division of Neurosurgery, St Jude Children's Hospital, USA
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17
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Manila A, Mariangela N, Libero L, Francesca G, Romana BF, Felice G. Is CRX protein a useful marker in differential diagnosis of tumors of the pineal region? Pediatr Dev Pathol 2014; 17:85-8. [PMID: 24555912 DOI: 10.2350/13-06-1346-oa.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The cone-rod homeobox (CRX) is a gene that belongs to the member of the orthodenticle homeobox (Otx) family, with important function in development and differentiation of retinal and pineal cells. Moreover, CRX appears to be specifically expressed in pineal tumors and retinoblastomas. We performed an immunohistochemical study on 91 pediatric and adult central nervous system tumors, plus 2 normal brain samples. Our results demonstrated that CRX is expressed not only in pineal parenchymal tumors and retinoblastoma, but also in a some medulloblastomas and supratentorial primitive neuroectodermal tumors. None of the glial tumors screened were positive for CRX. In conclusion, CRX could be useful in surgical neuropathology for the differential diagnosis of pineal region tumors, in particular to discriminate pineal tumors from glial tumors.
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Affiliation(s)
- Antonelli Manila
- 1 Department of Radiological, Oncological and Anatomo-Pathological Sciences, Sapienza University Viale Regina Elena 324, 00161 Rome, Italy
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18
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Abstract
In cases of pineal tumor combined with obstructive hydrocephalus, preoperative ventriculostomy or ventriculoperitoneal shunting is typically required prior to tumor resection. The objectives of preoperative ventriculostomy are gradual reduction of intracranial pressure and consequent preoperative brain protection. Here we report a case of pineal tumor resection with preoperative ventriculostomy that was complicated by multiple epidural hematomas. While postoperative intracranial hemorrhage may occur at any site, it is rare in those areas remote from the operative field. In the present case, multiple remote sequential epidural hematomas developed following resection of a pineal gland tumor. We also discuss the pathophysiologic mechanisms and provide a literature review.
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Affiliation(s)
- Jeong-Wook Lim
- Department of Neurosurgery, Daejeon Sun General Hospital, Daejeon, Korea
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19
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Abstract
The papillary tumor of the pineal region (PTPR) is a distinct entity that is particularly rare in the pediatric population. The authors document the youngest reported patient with this clinicopathological entity to date. A case of PTPR in a 15-month-old boy is described. Initially thought to be a tectal glioma, the tumor was later identified as a pineal region tumor after demonstrating growth on routine imaging. Diagnosis of PTPR was established by histopathological evaluation of biopsy samples, which revealed papillary, cystic, and solid tumor components. The patient's postoperative course was complicated by tumor growth despite several debulking procedures and chemotherapy, as well as persistent hydrocephalus requiring 2 endoscopic third ventriculostomies and eventual ventriculoperitoneal shunt placement. After a 15-month follow-up period, the patient has received proton-beam therapy and has a stable tumor size. The PTPR is a recently described tumor of the CNS that must be included in the differential diagnosis of pineal region masses. The biological behavior, prognosis, and appropriate treatment of PTPR have yet to be fully defined.
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Affiliation(s)
- Jessica Li
- Division of Pediatric Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Pablo F. Recinos
- Division of Pediatric Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland,Department of Neurosurgery, Cleveland Clinic, Cleveland, Ohio
| | - Brent A. Orr
- Division of Neuropathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Peter C. Burger
- Division of Pediatric Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland,Division of Neuropathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - George I. Jallo
- Division of Pediatric Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
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20
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Wright KD, Qaddoumi I, Patay Z, Gajjar A, Wilson MW, Rodriguez-Galindo C. Successful treatment of early detected trilateral retinoblastoma using standard infant brain tumor therapy. Pediatr Blood Cancer 2010; 55:570-2. [PMID: 20658634 PMCID: PMC3115715 DOI: 10.1002/pbc.22545] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Trilateral retinoblastoma is characterized by the presence of retinoblastoma with an intracranial tumor. The incidence is low and prognosis poor. Due to the paucity of information regarding successful treatment, we report the case of a 6 month old female referred for leukocoria and found to have an associated suprasellar tumor and pineal enhancement. The patient, treated with standard infant brain tumor therapy, remains alive without signs of active disease 35 months after diagnosis; no surgery or irradiation was used. Early diagnosis of trilateral retinoblastoma may facilitate the use of less intensive therapeutic approaches and result in excellent outcomes in these patients.
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Affiliation(s)
- Karen D. Wright
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, Tennessee,Department of Neuro-Oncology, St. Jude Children’s Research Hospital, Memphis, Tennessee,Correspondence to: Karen D. Wright, Department of Oncology, Division of Neuro-Oncology, St. Jude Children’s Research Hospital, 262 Danny Thomas Place, Mailstop 260, Memphis, TN 38105-3678.
| | - Ibrahim Qaddoumi
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, Tennessee,Department of Neuro-Oncology, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Zoltan Patay
- Department of Radiology, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Amar Gajjar
- Department of Neuro-Oncology, St. Jude Children’s Research Hospital, Memphis, Tennessee
| | - Matthew W. Wilson
- Department of Surgery, St. Jude Children’s Research Hospital, Memphis, Tennessee,Department of Ophthalmology and Hamilton Eye Institute, University of Tennessee, Memphis, Tennessee
| | - Carlos Rodriguez-Galindo
- Department of Pediatric Oncology, Dana-Farber Cancer Institute and Children’s Hospital Boston, Boston, Massachusetts
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