scholarly journals Epilepsy surgery related to pediatric brain tumors: Miami Children’s Hospital experience

2015 ◽  
Vol 16 (6) ◽  
pp. 675-680 ◽  
Author(s):  
Aria Fallah ◽  
Alexander G. Weil ◽  
Samir Sur ◽  
Ian Miller ◽  
Prasanna Jayakar ◽  
...  
Keyword(s):  
Standard Deviation ◽  
Brain Tumors ◽  
Epilepsy Surgery ◽  
Pediatric Patients ◽  
Pediatric Brain Tumors ◽  
Seizure Freedom ◽  
Seizure Recurrence ◽  
Children's Hospital ◽  
Pediatric Brain

OBJECT Pediatric brain tumors may be associated with medically intractable epilepsy for which surgery is indicated. The authors sought to evaluate the efficacy of epilepsy surgery for seizure control in pediatric patients with brain tumors. METHODS The authors performed a retrospective review of consecutive patients undergoing resective epilepsy surgery related to pediatric brain tumors at Miami Children’s Hospital between June 1986 and June 2014. Time-to-event analysis for seizure recurrence was performed; an “event” was defined as any seizures that occurred following resective epilepsy surgery, not including seizures and auras in the 1st postoperative week. The authors analyzed several preoperative variables to determine their suitability to predict seizure recurrence following surgery. RESULTS Eighty-four patients (47 males) with a mean age (± standard deviation) of 8.7 ± 5.5 years (range 0.5–21.6 years) were included. The study included 39 (46%) patients with gliomas, 20 (24%) with dysembryoplastic neuroepithelial tumors (DNETs), 14 (17%) with gangliogliomas, and 11 (13%) with other etiologies. Among the patients with gliomas, 18 were classified with low-grade glioma, 5 had oligodendroglioma, 6 had uncategorized astrocytoma, 3 had pilocytic astrocytoma, 3 had pleomorphic xanthoastrocytoma, 3 had glioblastoma, and 1 had gliomatosis cerebri. Seventy-nine (94.0%) resections were guided by intraoperative electrocorticography (ECoG). The mean time (± standard deviation) to seizure recurrence was 81.8 ± 6.3 months. Engel Class I outcome was achieved in 66 (78%) and 63 (75%) patients at 1 and 2 years’ follow-up, respectively. Patients with ganglioglioma demonstrated the highest probability of long-term seizure freedom, followed by patients with DNETs and gliomas. In univariate analyses, temporal location (HR 1.75, 95% CI 0.26–1.27, p = 0.171) and completeness of resection (HR 1.69, 95% CI 0.77–3.74, p = 0.191) demonstrated a trend toward a longer duration of seizure freedom. CONCLUSIONS ECoG-guided epilepsy surgery for pediatric patients with brain tumors is highly effective. Tumors located in the temporal lobe and those in which a complete ECoG-guided resection is performed may result in a greater likelihood of long-term seizure freedom.

scholarly journals Incidence, risk factors, and longitudinal outcome of seizures in long-term survivors of pediatric brain tumors

Epilepsia ◽  
2015 ◽  
Vol 56 (10) ◽  
pp. 1599-1604 ◽  
Author(s):  
Nicole J. Ullrich ◽  
Scott L. Pomeroy ◽  
Kush Kapur ◽  
Peter E. Manley ◽  
Liliana C. Goumnerova ◽  
...  
Keyword(s):  
Risk Factors ◽  
Brain Tumors ◽  
Pediatric Brain Tumors ◽  
Longitudinal Outcome ◽  
Incidence Risk ◽  
Long Term Survivors ◽  
Pediatric Brain

Tumor location and neurocognitive impairment in adult survivors of pediatric brain tumors: A report from the St. Jude Lifetime Cohort (SJLIFE).

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 9531-9531
Author(s):  
Tara M. Brinkman ◽  
Wei Liu ◽  
Gregory T. Armstrong ◽  
Amar J. Gajjar ◽  
Thomas E. Merchant ◽  
...  
Keyword(s):  
Brain Tumors ◽  
Processing Speed ◽  
Adult Survivors ◽  
Pediatric Brain Tumors ◽  
Tumor Location ◽  
Age At Diagnosis ◽  
Neurocognitive Functions ◽  
Pediatric Brain

9531 Background: Follow-up guidelines identify supratentorial tumor location as a risk factor for poor neurocognitive outcomes during childhood; yet few studies have systematically compared long-term cognitive outcomes between adult survivors of childhood infratentorial and supratentorial brain tumors. Methods: Neurocognitive functions were evaluated in 130 adult survivors of pediatric brain tumors (58 supratentorial and 72 infratentorial, mean [SD] current age = 27.4 years [5.2], age at diagnosis = 8.6 years [4.6], and time since diagnosis = 18.8 years [4.8]) participating in the SJLIFE long-term follow-up protocol. Age-adjusted standard scores for measures of intelligence, attention, memory, processing speed, and executive functioning were calculated, with clinical impairment defined as scores <10th percentile. Odds ratios (OR) and 95% confidence intervals (CI) were calculated using multivariable logistic regression models to examine associations between neurocognitive functions and tumor location. Results: As a group, survivors performed below average across multiple neurocognitive domains, including full scale IQ (mean=88.1; SD=18.2), with 34% demonstrating impaired IQ. Survivors of infratentorial tumors were more likely to be impaired on measures of focused attention (OR=2.19, 95% CI=1.03-4.65) and fine motor dexterity (OR=2.62, 95% CI=1.21-5.66) compared to survivors of supratentorial tumors. After adjusting for sex, age at diagnosis, shunt placement and cranial radiation (yes/no), infratentorial tumor location was only associated with reduced performance on a task of visual abstract reasoning (OR=3.76, 95% CI=1.40-10.1). Cranial radiation therapy was independently associated with impaired short-term memory (OR=15.6, 95% CI=1.64-147.8) and processing speed (OR=3.86, 95% CI=1.15-13.0). Conclusions: Tumor location was not associated with neurocognitive impairment after adjusting for treatment exposures. To further delineate potential differences associated with tumor location, future studies will examine factors including radiation dose/volume, extent of surgical resection, and medical complications.

Multilobar Epilepsy Surgery in Childhood and Adolescence: Predictors of Long-Term Seizure Freedom

Neurosurgery ◽  
2020 ◽  
Vol 88 (1) ◽  
pp. 174-182
Author(s):  
Evangelos Kogias ◽  
Thomas Bast ◽  
Susanne Schubert-Bast ◽  
Gert Wiegand ◽  
Armin Brandt ◽  
...  
Keyword(s):  
Epilepsy Surgery ◽  
Seizure Control ◽  
Focal Cortical Dysplasia ◽  
Benign Tumors ◽  
Seizure Freedom ◽  
Childhood And Adolescence ◽  
Epileptogenic Zone ◽  
Seizure Recurrence ◽  
Eloquent Cortex

Abstract BACKGROUND Although multilobar resections correspond to one-fifth of pediatric epilepsy surgery, there are little data on long-term seizure control. OBJECTIVE To investigate the long-term seizure outcomes of children and adolescents undergoing multilobar epilepsy surgery and identify their predictors. METHODS In this retrospective study, we considered 69 consecutive patients that underwent multilobar epilepsy surgery at the age of 10.0 ± 5.0 yr (mean ± SD). The magnetic resonance imaging revealed a lesion in all but 2 cases. Resections were temporo-parieto(-occipital) in 30%, temporo-occipital in 41%, parieto-occipital in 16%, and fronto-(temporo)-parietal in 13% cases. Etiologies were determined as focal cortical dysplasia in 67%, perinatal or postnatal ischemic lesions in 23%, and benign tumors in 10% of cases. RESULTS At last follow-up of median 9 yr (range 2.8-14.8), 48% patients were seizure free; 33% were off antiepileptic drugs. 10% of patients, all with dysplastic etiology, required reoperations: 4 of 7 achieved seizure freedom. Seizure recurrence occurred mostly (80%) within the first 6 mo. Among presurgical variables, only an epileptogenic zone far from eloquent cortex independently correlated with significantly higher rates of seizure arrest in multivariate analysis. Among postsurgical variables, the absence of residual lesion and of acute postsurgical seizures was independently associated with significantly higher rates of seizure freedom. CONCLUSION Our study demonstrates that multilobar epilepsy surgery is effective regarding long-term seizure freedom and antiepileptic drug withdrawal in selected pediatric candidates. Epileptogenic zones–and lesions–localized distant from eloquent cortex and, thus, fully resectable predispose for seizure control. Acute postsurgical seizures are critical markers of seizure recurrence that should lead to prompt reevaluation.

Management and Surveillance of Short- and Long-Term Sequelae of Radiation Therapy for the Treatment of Pediatric Brain Tumors

2020 ◽  
Vol 18 (06) ◽  
pp. 307-312
Author(s):  
Fred Chiu-Lai Lam ◽  
Ekkehard M Kasper ◽  
Anand Mahadevan
Keyword(s):  
Radiation Therapy ◽  
Brain Tumors ◽  
Pediatric Brain Tumors ◽  
Special Edition ◽  
Long Term Effects ◽  
Transition Into Adulthood ◽  
Short And Long Term ◽  
Pediatric Brain

AbstractRadiation therapy (RT) is a mainstay for the treatment of pediatric brain tumors. As improvements in and sophistication of this modality continue to increase the survival of patients, the long-term sequelae of RT pose significant challenges in the clinical management of this patient population as they transition into adulthood. In this special edition, we review the short- and long-term effects of RT for the treatment of pediatric brain tumors and the necessary surveillance required for follow-up.

Long-term sequelae after pediatric brain tumors: Their effect on disability and quality of life

1990 ◽  
Vol 18 (4) ◽  
pp. 304-310 ◽  
Author(s):  
Birgitta Lannering ◽  
Ildiko Marky ◽  
Anita Lundberg ◽  
Elisabeth Olsson
Keyword(s):  
Quality Of Life ◽  
Brain Tumors ◽  
Pediatric Brain Tumors ◽  
Pediatric Brain

scholarly journals Do Intratumoral And Peritumoral Apparent Diffusion Coefficient (ADC) Values Have A Role In The Diagnosis Of Pediatric Brain Tumors?

2020 ◽  
Author(s):  
Güleç Mert Doğan ◽  
Ahmet Sığırcı ◽  
Sevgi Taşolar ◽  
Aslınur Cengiz ◽  
Hilal Er Ulubaba ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Brain Tumors ◽  
Magnetic Resonance Image ◽  
Pediatric Patients ◽  
Pediatric Brain Tumors ◽  
Low Grade ◽  
High Grade ◽  
Apparent Diffusion ◽  
Adc Values ◽  
Pediatric Brain

INTRODUCTION: The motion of water particles within biological tissues, which is called random Brownian motion, is detected at the microscopic level by Diffusion-Weighted Imaging (DWI) sequence of Magnetic Resonance Image technique. The Apparent Diffusion Coefficient (ADC) calculated on DWI has been used for tumor diagnosis and grading. The purpose of this study was to evaluate of ADC values in the differential diagnosis of supratentorial and infratentorial pediatric brain tumors and to reveal the difference of peritumoral ADC measurements of pediatric patients from adult patients. METHODS: All of the 56 pediatric patients included in this retrospective study had lesions >1 cm in diameter on magnetic resonance image and all of the diagnosies were confirmed by histopathology. Intratumoral and peritumoral ADC values and ratios were measured in diffusion weighted Magnetic Resonance Image. RESULTS: The 58.9% (n=33) of these tumors were supratentorial and 41.1% (n=23) were infratentorial. ADC values and ADC ratios were significantly lower in high-grade tumors than low-grade tumors (p<0.05). Peritumoral ADC values in high-grade tumors were lower than low grade tumors (p<0.05). The cut-off value of the ADC ratio between these two groups was 1 and the ADC cut-off value was 1.1*10-3 mm2/s. DISCUSSION AND CONCLUSION: In the differentiation of low and high-grade pediatric brain tumors, cut-off values of 1.1*10_3mm2/s for ADC Value and 1.0 for ADC Ratio may be useful. Although, peritumoral ADC values differ in children compared to the adult group, both intratumoral and peritumoral ADC values can help for grading pediatric brain tumors.

scholarly journals Childhood Malignant Brain Tumors: Balancing the Bench and Bedside

Cancers ◽  
2021 ◽  
Vol 13 (23) ◽  
pp. 6099
Author(s):  
Colin Thorbinson ◽  
John-Paul Kilday
Keyword(s):  
Brain Tumors ◽  
Survival Rates ◽  
Rapid Evolution ◽  
Developed Countries ◽  
Pediatric Brain Tumors ◽  
Neuro Imaging ◽  
Pediatric Brain ◽  
Translational Therapy

Brain tumors are the leading cause of childhood cancer deaths in developed countries. They also represent the most common solid tumor in this age group, accounting for approximately one-quarter of all pediatric cancers. Developments in neuro-imaging, neurosurgical techniques, adjuvant therapy and supportive care have improved survival rates for certain tumors, allowing a future focus on optimizing cure, whilst minimizing long-term adverse effects. Recent times have witnessed a rapid evolution in the molecular characterization of several of the common pediatric brain tumors, allowing unique clinical and biological patient subgroups to be identified. However, a resulting paradigm shift in both translational therapy and subsequent survival for many of these tumors remains elusive, while recurrence remains a great clinical challenge. This review will provide an insight into the key molecular developments and global co-operative trial results for the most common malignant pediatric brain tumors (medulloblastoma, high-grade gliomas and ependymoma), highlighting potential future directions for management, including novel therapeutic options, and critical challenges that remain unsolved.

scholarly journals Antiseizure Medication Withdrawal in Seizure-Free Patients: Practice Advisory Update Summary

Neurology ◽  
2021 ◽  
Vol 97 (23) ◽  
pp. 1072-1081
Author(s):  
David Gloss ◽  
Kimberly Pargeon ◽  
Alison Pack ◽  
Jay Varma ◽  
Jacqueline A. French ◽  
...  
Keyword(s):  
Pediatric Patients ◽  
Seizure Freedom ◽  
Insufficient Evidence ◽  
Seizure Recurrence ◽  
Medication Withdrawal ◽  
Significant Difference ◽  
Practice Advisory ◽  
American Academy Of Neurology

ObjectiveTo update a 1996 American Academy of Neurology practice parameter.MethodsThe authors systematically reviewed literature published from January 1991 to March 2020.ResultsThe long-term (24–60 months) risk of seizure recurrence is possibly higher among adults who have been seizure-free for 2 years and taper antiseizure medications (ASMs) vs those who do not taper ASMs (15% vs 7% per the 1 Class I article addressing this issue). In pediatric patients, there is probably no significant difference in seizure recurrence between those who begin tapering ASMs after 2 years vs 4 years of seizure freedom, and there is insufficient evidence of significant difference in risk of seizure recurrence between those who taper ASMs after 18 months of seizure freedom and those tapering after 24 months. There is insufficient evidence that the rate of seizure recurrence with ASM withdrawal following epilepsy surgery after 1 year of seizure freedom vs after 4 years is not significantly different than maintaining patients on ASMs. An epileptiform EEG in pediatric patients increases the risk of seizure recurrence. ASM withdrawal possibly does not increase the risk of status epilepticus in adults. In seizure-free adults, ASM weaning possibly does not change quality of life. Withdrawal of ASMs at 25% every 10 days to 2 weeks is probably not significantly different from withdrawal at 25% every 2 months in children who are seizure-free in more than 4 years of follow-up.RecommendationsFourteen recommendations were developed.

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