Intraoperative MRI-guided Resection in Pediatric Brain Tumor Surgery: A Meta-analysis of Extent of Resection and Safety Outcomes

Abstract Background The objective of this meta-analysis was to analyze the impact of intraoperative magnetic resonance imaging (iMRI) on pediatric brain tumor surgery with regard to the frequency of histopathologic entities, additional resections secondary to iMRI, rate of gross total resections (GTR) in glioma surgery, extent of resection (EoR) in supra- and infratentorial compartment, surgical site infections (SSIs), and neurologic outcome after surgery. Methods MEDLINE/PubMed Service was searched for the terms “intraoperative MRI,” “pediatric,” “brain,” “tumor,” “glioma,” and “surgery.” The review produced 126 potential publications; 11 fulfilled the inclusion criteria, including 584 patients treated with iMRI-guided resections. Studies reporting about patients <18 years, setup of iMRI, surgical workflow, and extent of resection of iMRI-guided glioma resections were included. Results IMRI-guided surgery is mainly used for pediatric low-grade gliomas. The mean rate of GTR in low- and high-grade gliomas was 78.5% (207/254; 95% confidence interval [CI]: 64.6–89.7, p < 0.001). The mean rate of GTR in iMRI-assisted low-grade glioma surgery was 74.3% (35/47; 95% CI: 61.1–85.5, p = 0.759). The rate of SSI in surgery assisted by iMRI was 1.6% (6/482; 95% CI: 0.7–2.9). New onset of transient postoperative neurologic deficits were observed in 37 (33.0%) of 112 patients. Conclusion IMRI-guided surgery seems to improve the EoR in pediatric glioma surgery. The rate of SSI and the frequency of new neurologic deficits after IMRI-guided surgery are within the normal range of pediatric neuro-oncologic surgery.

Download Full-text

TRTH-02. STIMULATED RAMAN SCATTERING MICROSCOPY PROVIDES RAPID, DIAGNOSTIC HISTOPATHOLOGIC IMAGES DURING PEDIATRIC BRAIN TUMOR SURGERY

Neuro-Oncology ◽

10.1093/neuonc/nox083.214 ◽

2017 ◽

Vol 19 (suppl_4) ◽

pp. iv51-iv51

Author(s):

Todd Hollon ◽

Mia Garrard ◽

Jamaal Tarpeh ◽

Balaji Pandian ◽

Yashar Niknafs ◽

...

Keyword(s):

Brain Tumor ◽

Raman Scattering ◽

Stimulated Raman Scattering ◽

Pediatric Brain Tumor ◽

Tumor Surgery ◽

Brain Tumor Surgery ◽

Pediatric Brain ◽

Stimulated Raman

Download Full-text

PATH-21. TELOMERE LENGTH ANALYSIS OF CNS TUMORS IN THE PEDIATRIC BRAIN TUMOR ATLAS

Neuro-Oncology ◽

10.1093/neuonc/noaa222.656 ◽

2020 ◽

Vol 22 (Supplement_3) ◽

pp. iii428-iii428

Author(s):

Jo Lynn Rokita ◽

Krutika Gaonkar ◽

Heba Ijaz ◽

Daniel Miller ◽

Tasso Karras ◽

...

Keyword(s):

Brain Tumor ◽

Gene Mutations ◽

Pediatric Brain Tumor ◽

High Grade Glioma ◽

Pediatric Brain Tumors ◽

Low Grade ◽

Alternative Lengthening ◽

Length Analysis ◽

Telomere Lengthening ◽

Pediatric Brain

Abstract Subsets of pediatric cancers, including high grade glioma (pHGG), have high rates of uniquely long telomeres, associated with ATRX gene mutations and alternative lengthening of telomeres (ALT). Ultimately, these cancers may benefit from a therapy stratification approach. In order to identify and further characterize pediatric brain tumors with telomere lengthening (TL), we determined the intratelomeric content in silico from paired WGS of 918 tumors from CBTTC Pediatric Brain Tumor Atlas (PBTA). The results were highly concordant with experimental assays to determine ALT in a subset of 45 pHGG tumors from the set. Overall, 13% of the PBTA cohort had telomere lengthening. We confirmed the highest rate of TL (37%) in the pHGG cohort (37/100 tumors; 30/82 patients). There was no statistical difference in age, gender or survival in subset analysis. As expected, the patient pHGG tumors with telomere lengthening were enriched for ATRX mutations (60%, q= 1.76e-3). However, 6 tumors without ATRX mutation also had normal protein expression, suggesting a different mechanism of inactivation or TL. The pHGG tumors with telomere lengthening had increased mutational burden (q=8.98e-3) and included all known pHGG cases (n=6) in the cohort with replication repair deficiencies. Of interest, the second highest rate of telomere lengthening was 9 subjects (24%) in the craniopharyngioma cohort. None of the craniopharyngioma tumors had ATRX mutations or low ATRX expression, and 55% of those with TL had CTNNB1 mutations. Finally, lower rates of telomere lengthening were found in medulloblastoma (10%), ependymoma (10%), low grade astrocytoma (8%) and ganglioglioma (7/47, 15%).

Download Full-text

Exploiting Laboratory Insights to Improve Outcomes of Pediatric Central Nervous System Tumors

American Society of Clinical Oncology Educational Book ◽

10.1200/edbk_159149 ◽

2016 ◽

pp. e540-e546 ◽

Cited By ~ 2

Author(s):

Giles W. Robinson ◽

Hendrik Witt ◽

Adam Resnick

Keyword(s):

Brain Tumor ◽

Molecular Mechanisms ◽

Therapeutic Potential ◽

Pediatric Brain Tumor ◽

Pediatric Brain Tumors ◽

Low Grade ◽

Short Period ◽

Tumor Management ◽

The Impact ◽

Pediatric Brain

Over a relatively short period of time, owing to improvements in biotechnology, our ability to identify the molecular mechanisms within pediatric brain tumors has dramatically increased. These findings have reshaped the way that we describe these diseases and have provided insights into how to better treat these often devastating diseases. Although still far from reaching the full therapeutic potential these advancements hold, the impact of these findings is steadily taking hold of pediatric brain tumor management. In this article, we summarize the major discoveries within three common pediatric brain tumor categories; medulloblastoma, ependymoma, and low-grade glioma. We discuss the current impact of these findings on treatment and the direction these findings may take the field of pediatric neuro-oncology.

Download Full-text