Hyperacute Infarct on Intraoperative Diffusion Imaging of Pediatric Brain Tumor Surgery

ABSTRACT:Background:Brain neoplasms are the second-most prevalent cancer of childhood for which surgical resection remains the main treatment. Intraoperative MRI is a useful tool to optimize brain tumor resection. It is, however, not known whether intraoperative MRI can detect complications such as hyperacute ischemic infarcts.Methods:A retrospective analysis of pre- and intraoperative MRIs including DWI sequence and correlation with early and 3-month postoperative MRIs was conducted to evaluate the incidence of hyperacute arterial infarct during pediatric brain tumor resection. Patient demographics, pathological type, tumor location, resection type as well as preoperative tumoral vessel encasement, evolution of the area of restricted diffusion were collected and analyzed comparatively between the group with acute infarct and the control group. Extent of the hyperacute infarct was compared to both early postsurgical and 3-month follow-up MRIs.Results:Of the 115 cases, 13 (11%) developed a hyperacute arterial ischemic infarct during brain tumor resection. Tumoral encasement of vessels was more frequent in the infarct group (69%) compared to 25.5% in the control group. Four cases showed additional vessel irregularities on intraoperative MRI. On early follow-up, the infarcted brain area had further progressed in six cases and was stable in seven cases. No further progression was noted after the first week post-surgery.Conclusions:Hyperacute infarcts are not rare events to complicate pediatric brain tumor resection. Tumoral encasement of the circle of Willis vessels appears to be the main risk factor. Intraoperative DWI underestimates the final extent of infarcted tissue compared to early postsurgical MRI.

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NS-11LOW-FIELD POLESTAR N20 MOBILE iMR SYSTEM AS AN ADJUNCT FOR PEDIATRIC BRAIN TUMOR RESECTION: FEASIBILITY, USEFULNESS AND SAFETY

Neuro-Oncology ◽

10.1093/neuonc/now078.11 ◽

2016 ◽

Vol 18 (suppl 3) ◽

pp. iii129.2-iii129

Author(s):

Salinas Sanz Jose Antonio ◽

Brell Doval Marta ◽

Ibañez Dominguez Javier ◽

Guibelalde del Castillo Mercedes ◽

Rocabado Quintana Sergio Alejandro ◽

...

Keyword(s):

Brain Tumor ◽

Tumor Resection ◽

Pediatric Brain Tumor ◽

Brain Tumor Resection ◽

Pediatric Brain

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Bioreactance-guided fluid therapy for excision of a giant brain tumor in an infant under general anesthesia: A case report and literature review

Brain Science Advances ◽

10.26599/bsa.2021.9050007 ◽

2021 ◽

Vol 7 (3) ◽

pp. 199-206

Author(s):

Yao Chen ◽

Ting Fan

Keyword(s):

Brain Tumor ◽

Fluid Therapy ◽

Pediatric Patients ◽

Perioperative Management ◽

Tumor Resection ◽

Pediatric Brain Tumor ◽

Good Prognosis ◽

Brain Tumor Resection ◽

Coagulation Dysfunction ◽

Pediatric Brain

Pediatric patients are more likely to suffer from brain tumors. Surgical resection is often the optimal treatment. Perioperative management of pediatric brain tumor resection brings great challenges to anesthesiologists, especially for fluid therapy. In this case, the infant-patient was only 69-day-old, weighed 6 kg，but she was facing a gaint brain tumor (7.9 cm × 8.1 cm × 6.7 cm) excision. The infant was at great risks such as hemorrhagic shock, cerebral edema, pulmonary edema, congestive heart failure, coagulation dysfunction, etc. However, we tried to use the parameters obtained by bioreactance-based NICOM® device (Cheetah Medical) to guide the infant’s intraoperative fluid therapy, and successfully avoided these complications and achieved a good prognosis.

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Thirty-day readmission risk after intracranial tumor resection surgeries in children

Journal of Neurosurgery Pediatrics ◽

10.3171/2019.7.peds19272 ◽

2020 ◽

Vol 25 (2) ◽

pp. 97-105

Author(s):

M. Burhan Janjua ◽

Sumanth Reddy ◽

William C. Welch ◽

Amer F. Samdani ◽

Ali K. Ozturk ◽

...

Keyword(s):

Brain Tumor ◽

Private Insurance ◽

Tumor Resection ◽

Pediatric Brain Tumor ◽

Unplanned Readmission ◽

Electrolyte Disorders ◽

Index Event ◽

Brain Tumor Resection ◽

Pediatric Brain ◽

Readmission Risk

OBJECTIVEThe risk of readmission after brain tumor resection among pediatric patients has not been defined. The authors’ objective was to evaluate the readmission rates and predictors of readmission after pediatric brain tumor resection.METHODSNationwide Readmissions Database (NRD) data sets from 2010 to 2014 were searched for unplanned readmissions within 30 days of the discharge date after pediatric brain tumor resection. Patient demographic variables included sex, age, expected payment source (Medicaid or private insurance), and median annual household income. Readmission events for chemotherapy, radiation therapy, or further tumor resection were not included.RESULTSOf 282 patients (12.7%) readmitted within 30 days of the index event, the median time to readmission was 10 days (IQR 5–19 days). The most common reason for readmission was hydrocephalus, which accounted for 19% of readmission events. Other CNS-related complications (24%), surgical site infections or septicemia (14%), seizures (7%), and hematological disorders (7%) accounted for other major readmission events. The median charge for readmission events was $35,431, and the median length of readmission stay was 4 days. In multivariate regression, factors associated with a significant increase in readmission risk included Medicaid as the primary payor, discharge from the index event with home health services, and fluid and electrolyte disorders during the index event.CONCLUSIONSMore than 10% of pediatric brain tumor patients have unplanned readmission events within 30 days of discharge after tumor resection. Medicaid patients and those with preoperative or early postoperative fluid and electrolyte disturbances may benefit from early or frequent outpatient visits after tumor resection.

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Benefit of Static FET PET in Pretreated Pediatric Brain Tumor Patients with Equivocal Conventional MRI Results

Klinische Pädiatrie ◽

10.1055/a-1335-4844 ◽

2021 ◽

Author(s):

Frederik Grosse ◽

Florian Wedel ◽

Ulrich-Wilhelm Thomale ◽

Ingo Steffen ◽

Arend Koch ◽

...

Keyword(s):

Brain Tumor ◽

Tumor Tissue ◽

Pediatric Brain Tumor ◽

Ct Scans ◽

Tumor Patients ◽

Fet Pet ◽

Conventional Mri ◽

Pet Ct ◽

Pediatric Brain

Abstract Background MRI has shortcomings in differentiation between tumor tissue and post-therapeutic changes in pretreated brain tumor patients. Patients We assessed 22 static FET-PET/CT-scans of 17 pediatric patients (median age 12 years, range 2–16 years, ependymoma n=4, medulloblastoma n=4, low-grade glioma n=6, high-grade glioma n=3, germ cell tumor n=1, choroid plexus tumor n=1, median follow-up: 112 months) with multimodal treatment. Method FET-PET/CT-scans were analyzed visually by 3 independent nuclear medicine physicians. Additionally quantitative FET-Uptake for each lesion was determined by calculating standardized uptake values (SUVmaxT/SUVmeanB, SUVmeanT/SUVmeanB). Histology or clinical follow-up served as reference. Results Static FET-PET/CT reliably distinguished between tumor tissue and post-therapeutic changes in 16 out of 17 patients. It identified correctly vital tumor tissue in 13 patients and post-therapeutic changes in 3 patients. SUV-based analyses were less sensitive than visual analyses. Except from a choroid plexus carcinoma, all tumor entities showed increased FET-uptake. Discussion Our study comprises a limited number of patients but results corroborate the ability of FET to detect different brain tumor entities in pediatric patients and discriminate between residual/recurrent tumor and post-therapeutic changes. Conclusions We observed a clear benefit from additional static FET-PET/CT-scans when conventional MRI identified equivocal lesions in pretreated pediatric brain tumor patients. These results warrant prospective studies that should include dynamic scans.

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Use of an Offsite Intraoperative MRI Operating Theater for Pediatric Brain Tumor Surgery: Experience from a Singapore Children's Hospital

World Neurosurgery ◽

10.1016/j.wneu.2019.10.083 ◽

2020 ◽

Vol 135 ◽

pp. e28-e35

Author(s):

Sharon Y.Y. Low ◽

Evangeline H.L. Lim ◽

Lik Eng Loh ◽

Yee Hui Mok ◽

Yew Nam Siow ◽

...

Keyword(s):

Brain Tumor ◽

Pediatric Brain Tumor ◽

Intraoperative Mri ◽

Tumor Surgery ◽

Brain Tumor Surgery ◽

Operating Theater ◽

Children's Hospital ◽

Children’S Hospital ◽

Pediatric Brain

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Use of an ultra-low field intraoperative MRI system for pediatric brain tumor cases: initial experience with ?polestar n20?

Turkish Neurosurgery ◽

10.5137/1019-5149.jtn.5615-11.0 ◽

2012 ◽

Author(s):

Serdar Kaya ◽

Suleymen Deniz ◽

Bulent Duz ◽

Mehmet Daneyemez ◽

Engin Gonul

Keyword(s):

Brain Tumor ◽

Pediatric Brain Tumor ◽

Intraoperative Mri ◽

Initial Experience ◽

Low Field ◽

Pediatric Brain

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Improved neuropsychological outcomes following proton therapy relative to X-ray therapy for pediatric brain tumor patients

Neuro-Oncology ◽

10.1093/neuonc/noz070 ◽

2019 ◽

Vol 21 (7) ◽

pp. 934-943 ◽

Cited By ~ 18

Author(s):

Jeffrey P Gross ◽

Stephanie Powell ◽

Frank Zelko ◽

William Hartsell ◽

Stewart Goldman ◽

...

Keyword(s):

Brain Tumor ◽

Processing Speed ◽

Adaptive Functioning ◽

Pediatric Brain Tumor ◽

Neuropsychological Evaluation ◽

Tumor Patients ◽

X Ray ◽

Neuropsychological Outcomes ◽

Pediatric Brain

AbstractBackgroundSurvivors of pediatric brain tumors are at risk for impaired development in multiple neuropsychological domains. The purpose of this study was to compare neuropsychological outcomes of pediatric brain tumor patients who underwent X-ray radiotherapy (XRT) versus proton radiotherapy (PRT).MethodsPediatric patients who underwent either XRT or PRT and received posttreatment age-appropriate neuropsychological evaluation—including measures of intelligence (IQ), attention, memory, visuographic skills, academic skills, and parent-reported adaptive functioning—were identified. Multivariate analyses were performed to assess differences in neuropsychological outcomes and included tests for interaction between treatment cohort and follow-up time.ResultsBetween 1998 and 2017, 125 patients with tumors located in the supratentorial (17.6%), midline (28.8%), or posterior fossa (53.6%) compartments received radiation and had posttreatment neuropsychological evaluation. Median age at treatment was 7.4 years. The PRT patient cohort had higher estimated SES and shorter median time from radiotherapy completion to last neuropsychological evaluation (6.7 vs 2.6 y, P < 0.001). On multivariable analysis, PRT was associated with higher full-scale IQ (β = 10.6, P = 0.048) and processing speed (β = 14.4, P = 0.007) relative to XRT, with trend toward higher verbal IQ (β = 9.9, P = 0.06) and general adaptive functioning (β = 11.4, P = 0.07). Planned sensitivity analyses truncating follow-up interval in the XRT cohort re-demonstrated higher verbal IQ (P = 0.01) and IQ (P = 0.04) following PRT, with trend toward improved processing speed (P = 0.09).ConclusionsPRT is associated with favorable outcomes for intelligence and processing speed. Combined with other strategies for treatment de-intensification, PRT may further reduce neuropsychological morbidity of brain tumor treatment.

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Feasibility and efficacy of an extended trial of home-based working memory training for pediatric brain tumor survivors: a pilot study

Neuro-Oncology Practice ◽

10.1093/nop/npw015 ◽

2016 ◽

Vol 4 (2) ◽

pp. 111-120 ◽

Cited By ~ 3

Author(s):

Bonnie Carlson-Green ◽

Jennifer Puig ◽

Anne Bendel

Keyword(s):

Working Memory ◽

Brain Tumor ◽

Executive Functioning ◽

Late Effects ◽

Pediatric Brain Tumor ◽

Working Memory Training ◽

Memory Training ◽

Neurocognitive Late Effects ◽

Pediatric Brain

Abstract Background. Impaired working memory appears to play a key role in some of the neurocognitive late effects of pediatric brain tumor treatments, including declines in intellectual and executive functioning. Recent studies of pediatric cancer survivors suggest Cogmed® Working Memory Training is effective at improving working memory, although pediatric brain tumor survivors may demonstrate a less robust response than children with other cancers. The current study sought to determine if an extended course of Cogmed (35 sessions) was both feasible and efficacious for brain tumor survivors and if improvements were observable in near-transfer and far-transfer working memory measures as well as parent rating scores at 6 months post-treatment. Methods. Twenty pediatric brain tumor survivors ages 8 to 18 years with working memory deficits completed 35 sessions of Cogmed. Assessments of working memory and academic skills were completed at baseline, completion of training, and 6-month follow-up and parents completed questionnaires at baseline and 6-month follow-up. Results. Participants showed significant improvements in working memory at training completion and 6-month follow-up and math achievement at 6-month follow-up. Parents reported executive functioning improvements at follow-up as compared with baseline. Participants’ program-based working memory skills did not change significantly between sessions 25 and 35, suggesting that extended training did not provide additional benefit. Conclusions. This study replicates and extends previous research by: (1) demonstrating that brain tumor survivors at high risk for neurocognitive late effects can complete and benefit from working memory training, (2) identifying a point of diminished returns on training time investment, and (3) demonstrating benefits 6 months post-intervention.

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LGG-32. CLINICAL OUTCOME OF PEDIATRIC GLIOMAS IN SINGLE INSTITUTION

Neuro-Oncology ◽

10.1093/neuonc/noaa222.414 ◽

2020 ◽

Vol 22 (Supplement_3) ◽

pp. iii372-iii372

Author(s):

Hiroyuki Uchida ◽

Nayuta Higa ◽

Hajime Yonezawa ◽

Tatsuki Oyoshi ◽

Koji Yoshimoto

Keyword(s):

Brain Tumor ◽

Tumor Resection ◽

Treatment Strategies ◽

Pediatric Brain Tumor ◽

University Hospital ◽

Subependymal Giant Cell Astrocytoma ◽

Histopathological Diagnosis ◽

Tumor Patients ◽

Who Grade ◽

Pediatric Brain

Abstract Gliomas in children are rarer than in adult, then treatment strategies might vary from facility to facility. We report clinical features and outcome of pediatric glioma in our institution. Twenty-nine patients diagnosed with glioma, exclude ependymoma, 14 boys and 15 girls, among 98 pediatric brain tumor patients treated at Kagoshima University Hospital since 2006 were reviewed histopathology, extent of resection, adjuvant therapy and outcome, etc. Mean age at surgery was 10.4 (S.D. 5.6) years. Median follow-up period was 19.1 months. Histopathological diagnosis comprised 8 pilocytic astrocytoma, 3 ganglioglioma, 2 subependymal giant cell astrocytoma, 5 WHO grade Ⅱ astrocytoma, 8 glioblastoma, and desmoplastic infantile astrocytoma, anaplastic astrocytoma and astroblastoma were one case each. Tumor resection was performed in 24 cases, and 5 cases underwent biopsy. Chemotherapy was performed in 15 cases and irradiation was performed in 9 cases. Out of 5 WHO grade Ⅱ astrocytoma cases, 2 cases underwent biopsy following chemotherapy, 1 case underwent biopsy only and other 1 case underwent total resection. The four cases show long survival ranged from 71 to 136 months without irradiation. All of eight glioblastoma cases show poor prognosis ranged from 8.6 to 26.7 months regardless of chemo-radiotherapy. In management for pediatric brain tumor patients, irradiation is often laid over until recurrence. In WHO grade Ⅱ astrocytoma, the treatment strategy might be reasonable using appropriate chemotherapy even though biopsy cases.

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