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

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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Hyperacute Infarct on Intraoperative Diffusion Imaging of Pediatric Brain Tumor Surgery

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/cjn.2019.226 ◽

2019 ◽

Vol 46 (5) ◽

pp. 550-558 ◽

Cited By ~ 1

Author(s):

Christine Saint-Martin ◽

Sergio Apuzzo ◽

Ayat Salman ◽

Jean-Pierre Farmer

Keyword(s):

Brain Tumor ◽

Brain Area ◽

Tumor Resection ◽

Pediatric Brain Tumor ◽

Intraoperative Mri ◽

Control Group ◽

Post Surgery ◽

Brain Tumor Resection ◽

Pediatric Brain

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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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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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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SURG-17. CLINICAL CHARACTERISTICS AND OUTCOMES OF EPILEPSY-RELATED BRAIN TUMOR IN CHILDREN

Neuro-Oncology ◽

10.1093/neuonc/noaa222.812 ◽

2020 ◽

Vol 22 (Supplement_3) ◽

pp. iii463-iii463

Author(s):

Kenichi Usami ◽

Keita Terashima ◽

Yuichi Abe ◽

Chikako Kiyotani ◽

Hideki Ogiwara

Keyword(s):

Brain Tumor ◽

Clinical Characteristics ◽

Tumor Resection ◽

Intractable Epilepsy ◽

Pediatric Brain Tumor ◽

Pediatric Epilepsy ◽

Dysembryoplastic Neuroepithelial Tumor ◽

Initial Surgery ◽

Age At Surgery ◽

Pediatric Brain

Abstract OBJECTIVE Epilepsy is one of the earliest symptoms in pediatric brain tumor. Gross total resection (GTR) of the tumor does not necessarily achieve seizure free, therefore it is controversial whether surrounding epileptic foci should be resected at the initial surgery. The aims of this study are to report clinical characteristics and outcome of pediatric epilepsy-related brain tumor (ERBT) and to discuss treatment strategy. METHODS Subjects were children less than 18 years old who underwent surgery for ERBT. Patients in whom epilepsy had been controlled before surgery were excluded. Data were collected from medical record and retrospectively reviewed. RESULTS Twenty-one children (8 boys and 13 girls) were analyzed in this study. The mean age at surgery was 6.8 years. Tumor was astrocytic tumor in 10, gangliogioma in 4 and dysembryoplastic neuroepithelial tumor in 3. Intracranial subdural electrodes were placed prior to tumor resection in 5 cases. GTR was achieved in 14 (67%). Seizure free was achieved in 15 (71.4%). GTR was significantly associated with seizure free (p=0.002). CONCLUSION In most of ERBT, seizure free can be achieved by lesionectomy alone. However, the resection of surrounding epileptic foci is required in some cases. Detailed examinations to detect the epileptic foci should be performed in ERBT, particularly in case of drug-resistant intractable epilepsy.

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LINC-23. PRE-OPERATIVE AND POST-OPERATIVE INTERVENTIONS REDUCE RATES OF VENTRICULITIS IN PEDIATRIC BRAIN TUMOR PATIENTS: A PILOT STUDY

Neuro-Oncology ◽

10.1093/neuonc/noaa222.457 ◽

2020 ◽

Vol 22 (Supplement_3) ◽

pp. iii382-iii383

Author(s):

Laura Melissa Stephanie Diamante - San ◽

Marciel Pedro ◽

Ana Patricia Alcasabas ◽

Marissa Lukban ◽

Kathleen Khu ◽

...

Keyword(s):

Brain Tumor ◽

Length Of Stay ◽

Wound Care ◽

Tumor Resection ◽

Hospital Setting ◽

Pediatric Brain Tumor ◽

Cost Of Care ◽

Clinical Practices ◽

Care Protocol ◽

Pediatric Brain

Abstract BACKGROUND The Philippine General Hospital, a public national referral center, sees 60–80 pediatric brain tumor cases per year. Historically, the rate of post-operative ventriculitis has been high, resulting in treatment delays and poor outcomes. Starting in July 2019, as a means to decrease infections, patients were provided standardized bathing and wound care kits and caregivers were trained to follow a bathing and wound care protocol. METHODS This quality improvement study included patients younger than 18 years who underwent craniotomy at PGH were enrolled. The type of surgery, length of surgery, existence of post-operative CNS infection, length of stay and total cost of care was collected. The outcome of these interventions are analyzed 6 months after implementation. RESULTS Thirty-two 32 patients were included, with mean age of 7 years (1–16). The surgeries performed were: tumor resection (n=20), ventriculo-peritoneal shunt insertion (VPS) (n=3), endoscopic third ventriculostomy (n=3), resection with tube ventriculostomy (n=3), Ommaya reservoir placement (n=2), and resection with shunt (n=1). Median surgery time was 4 hours (1–10). Three patients (9.4%) developed ventriculitis. No surgical site infections occurred. Compared to historical controls, a lower rate of infections was noted (9.4% vs. 15.5%, runchart analysis). Patients without post-operative infections had a shorter length of stay (median 14 vs 48 days, p<0.05) and a lower cost of care (median $1098 vs. $2425 USD, p<0.05). CONCLUSION Implementation of simple hygiene interventions effectively lowered post-operative CNS infections and hospital costs in a public hospital setting. Incorporation of these into standard clinical practices is urgently needed.

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