Cranial magnetic resonance imaging findings of leptomeningeal contrast enhancement after pediatric posterior fossa tumor resection and its significance

In this report, the authors illustrate the potential shortfalls of early postoperative MR imaging following resection of a posterior fossa tumor. The authors present the cases of a 10-month-old boy and a 14-year-old boy with posterior fossa tumors that were surgically resected and monitored immediately postoperatively with MR imaging. The MR imaging study obtained immediately postresection while the children were still anesthetized revealed enhancing elements in both patients, which were suggestive of leptomeningeal metastases. When this signal was followed on subsequent MR images, it was no longer visible. The patients are both recurrence free at the time of this publication. These cases demonstrate that early postoperative MR imaging findings for leptomeningeal metastases may be unreliable after excision of posterior fossa tumors and may have potential implications for intraoperative MR imaging techniques currently under development.

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“Drowning Brain in a Pool of CSF” — A Rare Complication of Periencephalic Subdural Panhygroma following Removal of a Posterior Fossa Tumor

Indian Journal of Neurosurgery ◽

10.1055/s-0037-1602751 ◽

2017 ◽

Vol 07 (03) ◽

pp. 223-226

Author(s):

Bikash Behera ◽

Ram Deo ◽

Sanjib Mishra ◽

Jyotirmayee Biswal ◽

Deepak Das

Keyword(s):

Posterior Fossa ◽

Case Reports ◽

Rare Complication ◽

Tumor Resection ◽

Foramen Magnum ◽

Posterior Fossa Tumor ◽

Subdural Hygroma ◽

Posterior Fossa Tumors ◽

Suboccipital Craniotomy ◽

Pediatric Age Group

AbstractPosterior fossa tumors are commonly encountered in pediatric age group patients. Most of these tumors present with features of hydrocephalus in the child. Conventionally, these cases are managed by suboccipital craniotomy with decompression of the tumor mass to establish the free flow of cerebrospinal fluid (CSF) across fourth ventricle and aqueduct of Sylvius. Following resection of posterior fossa tumor, appearance of subdural hygroma is a rare phenomenon.Though few cases of subdural hygroma are reported in literature following foramen magnum decompression in Chiari's malformation, their appearance following posterior fossa tumor resection is alien to medical literature and limited to only two case reports. Here the authors present a patient with periencephalic subdural panhygroma (PSP) following posterior fossa tumor resection who was successfully treated with a ventriculoperitoneal shunt (VPS) to accomplish a symptomatic and radiologic remission.

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The pathophysiology of oral pharyngeal apraxia and mutism following posterior fossa tumor resection in children

Journal of Neurosurgery ◽

10.3171/jns.1995.83.3.0467 ◽

1995 ◽

Vol 83 (3) ◽

pp. 467-475 ◽

Cited By ~ 101

Author(s):

Andrew T. Dailey ◽

Guy M. McKhann ◽

Mitchel S. Berger

Keyword(s):

Posterior Fossa ◽

Pediatric Patients ◽

Tumor Resection ◽

Posterior Fossa Tumor ◽

Posterior Fossa Tumors ◽

Lower Cranial Nerve ◽

Content Type ◽

Cranial Nerve Function ◽

Pharyngeal Musculature ◽

Fine Print

✓ Mutism following posterior fossa tumor resection in pediatric patients has been previously recognized, although its pathophysiology remains unclear. A review of the available literature reveals 33 individuals with this condition, with only a few adults documented in the population. All of these patients had large midline posterior fossa tumors. To better understand the incidence and anatomical substrate of this syndrome, the authors reviewed a 7-year series of 110 children who underwent a posterior fossa tumor resection. During that time, nine (8.2%) of the 110 children exhibited mutism postoperatively. They ranged from 2.5 to 20 years of age (mean 8.1 years) and became mute within 12 to 48 hours of surgery. The period of mutism lasted from 1.5 to 12 weeks after onset: all children had difficulty coordinating their oral pharyngeal musculature as manifested by postoperative drooling and inability to swallow. Further analysis of these cases revealed that all children had splitting of the entire inferior vermis at surgery, as confirmed on postoperative magnetic resonance studies. Lower cranial nerve function was intact in all nine patients. Current concepts of cerebellar physiology emphasize the importance of the cerebellum in learning and language. The syndrome described resembles a loss of learned activities, or an apraxia, of the oral and pharyngeal musculature. To avoid the apraxia, therefore, the inferior vermis must be preserved. For large midline tumors that extend to the aqueduct, a combined approach through the fourth ventricle and a midvermis split may be used to avoid injuring the inferior vermis.

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Prone Positioning for Posterior Fossa Tumor Resection

10.1093/med/9780199764495.003.0037 ◽

2013 ◽

Author(s):

Matthias W König ◽

Mohamed A Mahmoud ◽

John J McAuliffe

Keyword(s):

Brain Tumors ◽

Prone Position ◽

Posterior Fossa ◽

Tumor Resection ◽

Posterior Fossa Tumor ◽

Physiological Changes ◽

Prone Positioning ◽

Posterior Fossa Tumors ◽

Common Malignancy

Brain tumors are the second most common malignancy in children. About one third occur in toddlers under the age of 3, and about two thirds are located in the posterior fossa. Resection of posterior fossa tumors is often a lengthy procedure that is commonly performed in the prone position. The prone position is associated with physiological changes and predisposes the patient to certain types of injuries.

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140 The Effect of Hospital Case-Volume on Pediatric Patients with Resected Posterior Fossa Tumors

Neurosurgery ◽

10.1093/neuros/nyx417.140 ◽

2017 ◽

Vol 64 (CN_suppl_1) ◽

pp. 233-233

Author(s):

Annie Isabelle Drapeau ◽

David M Kline ◽

Adrienne Boczar ◽

Julie Leonard ◽

Jeffrey R Leonard

Keyword(s):

Quality Of Care ◽

Posterior Fossa ◽

Geometric Mean ◽

Tumor Resection ◽

High Volume ◽

Posterior Fossa Tumor ◽

Posterior Fossa Tumors ◽

Discharge Home ◽

Low Volume

Abstract INTRODUCTION Higher volume hospitals correlate with improved markers of quality of care in various surgical specialties. The purpose of this study was to investigate the effect of volume on the outcomes of children undergoing posterior fossa tumor resection. METHODS We queried the Pediatric Health Information System (PHIS) for children ages 0–17 years undergoing posterior fossa tumor resection between 2011 and 2015. Length of hospital stay (LOS), routine discharge home, and adjusted total cost were analyzed for associations with hospital volume (low, medium and high categories, or continuous variable) adjusted for patient demographic and clinical characteristics. LOS was defined as time to routine discharge with patients not routinely discharged censored at time of disposition. RESULTS >A mean of 2893 children per year underwent surgery in 49 U.S. hospitals. The hazard of routine discharge in high volume hospitals was 27% higher than medium (P = 0.0010) and 28% higher than low (P = 0.0003), reflecting shorter LOS in high volume centers. As a binary endpoint, the odds ratios for routine discharge were 1.50 (P = 0.2417), 2.07 (P = 0.0303), and 1.38 (P = 0.2417) for high vs. medium, high vs. low, and medium vs. low volume hospitals, respectively. The geometric mean costs in high volume hospitals were 59% and 37% less than in medium (P = 0.0158) and low volume hospitals (P = 0.1858), respectively. An increase in average annual volume of 50 patients (continuous covariate analysis) increased the hazard of routine discharge by 13% (P = 0.0002), increased the odds of routine discharge by 32% (P = 0.0892), and reduced the geometric mean cost by 27% (P = 0.0767). CONCLUSION Higher volume hospitals in PHIS had improved quality of care (shorter hospital LOS, increased discharge home, and reduced costs) for children requiring posterior fossa tumor resection. Referral to higher volume children's hospitals may improve outcomes for children with newly diagnosed posterior fossa tumors.

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Integrated positron emission tomography and magnetic resonance imaging–guided resection of brain tumors: a report of 103 consecutive procedures

Journal of Neurosurgery ◽

10.3171/jns.2006.104.2.238 ◽

2006 ◽

Vol 104 (2) ◽

pp. 238-253 ◽

Cited By ~ 102

Author(s):

Benoît Pirotte ◽

Serge Goldman ◽

Olivier Dewitte ◽

Nicolas Massager ◽

David Wikler ◽

...

Keyword(s):

Positron Emission Tomography ◽

Brain Tumors ◽

Mr Imaging ◽

Tumor Resection ◽

Tracer Uptake ◽

Emission Tomography ◽

Mr Images ◽

Pet Tracer ◽

Positron Emission ◽

Pet Scanning

Object The aim of this study was to evaluate the integration of positron emission tomography (PET) scanning data into the image-guided resection of brain tumors. Methods Positron emission tomography scans obtained using fluorine-18 fluorodeoxyglucose (FDG) and l-[methyl-11C]methionine (MET) were combined with magnetic resonance (MR) images in the navigational planning of 103 resections of brain tumors (63 low-grade gliomas [LGGs] and 40 high-grade gliomas [HGGs]). These procedures were performed in 91 patients (57 males and 34 females) in whom tumor boundaries could not be accurately identified on MR images for navigation-based resection. The level and distribution of PET tracer uptake in the tumor were analyzed to define the lesion contours, which in turn yielded a PET volume. The PET scanning–demonstrated lesion volume was subsequently projected onto MR images and compared with MR imaging data (MR volume) to define a final target volume for navigation-based resection—the tumor contours were displayed in the microscope’s eyepiece. Maximal tumor resection was accomplished in each case, with the intention of removing the entire area of abnormal metabolic activity visualized during surgical planning. Early postoperative MR imaging and PET scanning studies were performed to assess the quality of tumor resection. Both pre- and postoperative analyses of MR and PET images revealed whether integrating PET data into the navigational planning contributed to improved tumor volume definition and tumor resection. Metabolic information on tumor heterogeneity or extent was useful in planning the surgery. In 83 (80%) of 103 procedures, PET studies contributed to defining a final target volume different from that obtained with MR imaging alone. Furthermore, FDG-PET scanning, which was performed in a majority of HGG cases, showed that PET volume was less extended than the MR volume in 16 of 21 cases and contributed to targeting the resection to the hypermetabolic (anaplastic) area in 11 (69%) of 16 cases. Performed in 59 LGG cases and 23 HGG cases, MET-PET demonstrated that the PET volume did not match the MR volume and improved the tumor volume definition in 52 (88%) of 59 and 18 (78%) of 23, respectively. Total resection of the area of increased PET tracer uptake was achieved in 54 (52%) of 103 procedures. Conclusions Imaging guidance with PET scanning provided independent and complementary information that helped to assess tumor extent and plan tumor resection better than with MR imaging guidance alone. The PET scanning guidance could help increase the amount of tumor removed and target image-guided resection to tumor portions that represent the highest evolving potential.

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Poster 389 Acute Inpatient Rehabilitation in Children with Recent Posterior Fossa Tumor Resection: A Case Series

PM&R ◽

10.1016/j.pmrj.2015.06.426 ◽

2015 ◽

Vol 7 ◽

pp. S218-S219

Author(s):

Nikola Dragojlovic ◽

Zachary Wirt ◽

Christian Niedzwecki

Keyword(s):

Posterior Fossa ◽

Tumor Resection ◽

Case Series ◽

Inpatient Rehabilitation ◽

Posterior Fossa Tumor

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Accelerated spondylotic changes adjacent to the fused segment following central cervical corpectomy: magnetic resonance imaging study evidence

Journal of Neurosurgery Spine ◽

10.3171/spi.2004.100.1.0002 ◽

2004 ◽

Vol 100 (1) ◽

pp. 2-6 ◽

Cited By ~ 29

Author(s):

Vaijayantee Kulkarni ◽

Vedantam Rajshekhar ◽

Lakshminarayan Raghuram

Keyword(s):

Magnetic Resonance ◽

Mr Imaging ◽

Imaging Study ◽

Degenerative Changes ◽

Adjacent Segment ◽

Mr Images ◽

Short Term ◽

Content Type ◽

Fine Print

Object. The authors studied whether cervical spine motion segments adjacent to a fused segment exhibit accelerated degenerative changes on short-term follow-up magnetic resonance (MR) imaging. Methods. Preoperative and short-term follow-up (mean duration 17.5 months, range 10–48 months) cervical MR images obtained in 44 patients who had undergone one- or two-level corpectomy for cervical spondylotic myelopathy were evaluated qualitatively and quantitatively. The motion segment adjacent to the fused segment and a segment remote from the fused segment were evaluated for indentation of the thecal sac, disc height, and sagittal functional diameter of the spinal canal on midsagittal T2-weighted MR images. Thecal sac indentations were classifed as mild, moderate, and severe. New indentations of the thecal sac of varying severity (mild in 17 patients [38.6%], moderate in 10 [22.7%], and severe in six [13.6%]) had developed at the adjacent segments in 33 (75%) of 44 patients. The degenerative changes were seen at the superior level in 11 patients, inferior level in 10 patients, and at both levels in 12 patients and resulted from both anterior and posterior element degeneration in the majority (23 [69.6%]) of patients. The remote segments showed mild thecal sac indentations in seven patients and moderate indentations in two patients (nine [20.5%] of 44). Compared with the changes at the remote segment, the canal size was significantly decreased at the superior adjacent segment by 0.9 mm (p = 0.007). No patient sustained a new neurological deficit due to adjacent-segment changes. Conclusions. On short-term follow-up MR imaging, levels adjacent to the fused segment exhibited more pronounced degenerative changes (compared with remote levels) in 75% of patients who had undergone one- or two-level central corpectomy.

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Cerebellar mutism after posterior fossa tumor resection in children: a multicenter international retrospective study to determine possible modifiable factors

Child s Nervous System ◽

10.1007/s00381-019-04058-7 ◽

2019 ◽

Vol 36 (6) ◽

pp. 1159-1169 ◽

Cited By ~ 4

Author(s):

Bryan Renne ◽

Julia Radic ◽

Deepak Agrawal ◽

Brittany Albrecht ◽

Christopher M. Bonfield ◽

...

Keyword(s):

Retrospective Study ◽

Posterior Fossa ◽

Tumor Resection ◽

Posterior Fossa Tumor ◽

Cerebellar Mutism ◽

Modifiable Factors

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Fluorescence-guided resection of glioblastoma multiforme utilizing 5-ALA-induced porphyrins: a prospective study in 52 consecutive patients

Journal of Neurosurgery ◽

10.3171/jns.2000.93.6.1003 ◽

2000 ◽

Vol 93 (6) ◽

pp. 1003-1013 ◽

Cited By ~ 575

Author(s):

Walter Stummer ◽

Alexander Novotny ◽

Herbert Stepp ◽

Claudia Goetz ◽

Karl Bise ◽

...

Keyword(s):

Glioblastoma Multiforme ◽

Mr Imaging ◽

Aminolevulinic Acid ◽

Univariate Analysis ◽

Tumor Resection ◽

Mr Images ◽

Content Type ◽

Tissue Fluorescence ◽

Solid Fluorescence ◽

Fine Print

Object. It has been established that 5-aminolevulinic acid (5-ALA) induces the accumulation of fluorescent porphyrins in glioblastoma multiforme (GBM), a phenomenon potentially exploitable to guide tumor resection. In this study the authors analyze the influence of fluorescence-guided resection on postoperative magnetic resonance (MR) imaging and survival in a series of patients who underwent surgery in the authors' department.Methods. Fifty-two consecutive patients with GBM received oral doses of 5-ALA (20 mg/kg body weight) 3 hours before induction of anesthesia. Intraoperatively, tumor fluorescence was visualized using a modified operating microscope. Fluorescing tissue was removed whenever it was considered safely possible. Residual enhancement on early postoperative MR imaging was quantified and related to each patient's characteristics to determine which factors influenced resection. Survival was analyzed using the Kaplan—Meier method and multivariate analysis was performed in which the Karnofsky Performance Scale (KPS) score, residual fluorescence, patient age, and residual enhancement on MR images were considered.Intraoperatively, two fluorescence qualities were perceived: solid fluorescence generally reflected coalescent tumor, whereas vague fluorescence mostly corresponded to infiltrative tumor. Complete resection of contrast-enhancing tumor was accomplished in 33 patients (63%). Residual intraoperative tissue fluorescence left unresected for safety reasons predicted residual enhancement on MR images in 18 of the 19 remaining patients. Age, residual solid fluorescence, and absence of contrast enhancement in MR imaging were independent explanatory factors for survival, whereas the KPS score was significant only in univariate analysis. No perioperative deaths and one case of permanent morbidity were encountered.Conclusions. The observations in this study indicate the usefulness of 5-ALA—induced tumor fluorescence for guiding tumor resection. The completeness of resection, as determined intraoperatively from residual tissue fluorescence, was related to postoperative MR imaging findings and to survival in patients suffering from GBM.

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