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. 2014 Jun;16(Suppl 1):i105–i108. doi: 10.1093/neuonc/nou077

NEUROSURGERY

PMCID: PMC4046293
Neuro Oncol. 2014;16(Suppl 1):i105–i108. doi: 10.1093/neuonc/nou077.1

NS-001. CONFOCAL LASER ENDOMICROSCOPY: A GENERAL DESCRIPTION OF A NEW TECHNIQUE FOR PERFORMING OPTICAL BIOPSIES IN NEUROSURGERY

Cleopatra Charalampaki 1, Christian Eyth 1, Mirwais Morgan 1

Abstract

INTRODUCTION: Early detection and evaluation of brain tumors during surgery is crucial for accurate resection. Currently cryosections during surgery are regularly performed. Confocal laser endoscopy (CLE) is a novel technique permitting in vivo histologic imaging with miniaturized endoscopic probes at excellent resolution. Aim of the project is to evaluate CLE for in vivo diagnosis in different types and models of intracranial neoplasia, and found out its intraoperative usability for better resection of malignant brain tumors. METHODS: To evaluate the surgical application in patients, fresh surgical resection specimen of human intracranial and spinal tumors were examined (glioblastoma multiforme, meningioma, craniopharyngioma, acoustic neurinoma, spinal neurinomas, brain and spine metastasis, medulloblastoma, epidermoid tumor). Healthy tissue adjacent to the samples served as control and was used for better differentiation between normal and pathological tissue. RESULTS: CLE yielded high-quality histomorphology of normal brain tissue and tumors. Different fluorescent agents revealed distinct aspects of tissue and cell structure (nuclear pattern, axonal pathways, hemorrhages). CLE discrimination of neoplastic from healthy brain tissue was easy to perform based on tissue and cellular architecture and resemblance with histopathology was excellent. CONCLUSION: Confocal endomicroscopy is a developing method for diagnosis of various neurosurgical disorders. It provides real-time images to aid in the diagnosis and management for these conditions. CLE also achieves a more targeted optical biopsy of the abnormal tissue to expedite the therapeutic planning and decisions regarding surgical intervention. Future trends in confocal endomicroscopy include the wide spread use of molecular imaging with labeled peptides to aid in a more accurate diagnosis of malignancies and for therapeutic planning.

Neuro Oncol. 2014;16(Suppl 1):i105–i108. doi: 10.1093/neuonc/nou077.2

NS-002. CONFOCAL LASER ENDOMICROSCOPY FOR REAL TIME HISTOMORPHOLOGICAL DIAGNOSIS: OUR CLINICAL EXPERIENCE WITH 150 BRAIN AND SPINAL TUMOR CASES

Cleopatra Charalampaki 1, Christian Eyth 1, Mirwais Morgan 1

Abstract

INTRODUCTION: Confocal laser endoscopy (CLE) is a novel technique permitting in vivo histologic imaging with miniaturized endoscopic probes at excellent resolution. Goal was: 1) to analyze the technical aspects of CLE technique, 2) to investigate the integration of CLE in the neurosurgical daily workflow in the operation room, 3) to create an easily integration of the CLE technique into the neurosurgical daily routine used endoscopic setting and providing immediate and intraoperativ histopathologic diagnosis of the entire entity on real time, and 4) to evaluate CLE for in vivo diagnosis in different types and models of intracranial and intraspinal neoplasia. METHODS: Fresh surgical biopsies of 150 intracranial and intraspinal lesions were examined to test the signal intensity and adequate contrast for CLE imaging after topical application of 0.1ml acriflavine. The lesions examined were different grades of glioma, meningiomas, craniopharyngiomas, different types of intrasellar lesions, acoustic neurinomas, spinal neurinomas, different brain metastasis, medulloblastomas, epidermoid tumors, spinal and in brain located ependymomas. RESULTS: CLE equipment was easily integrated into the daily routine. We additionally combined the CLE equipment, with the microscopes and endoscopes in a picture in picture modus. The insertion of the CLE optical probe into the working channel of conventional brain endoscopes was easy to performed. CLE discrimination of neoplastic tissue was easy to perform based on tissue and cellular architecture. The resemblance with histopathology was excellent. DISCUSSION: These findings might have impact on our future clinical approach to intracranial neoplasia and other forms of cancer. Confocal laser endomicroscopy allows immediate in vivo imaging of normal and neoplastic brain tissue at high resolution. It may become helpful to screen for tumor free margins not only for improving the real time histological definition of the tumor tissue, but also increasing the ability to accurate surgical resection of malignant brain tumors on a cellular level.

Neuro Oncol. 2014;16(Suppl 1):i105–i108. doi: 10.1093/neuonc/nou077.3

NS-003. CONFOCAL LASER ENDOMICROSCOPIC (CLE) CHARACTERIZATION AND DIFFERENTIATION OF BRAIN METASTASIS

Cleopatra Charalampaki 1, Christian Eyth 1, Mirwais Morgan 1

Abstract

INTRODUCTION: Metastatic tumors are among the most common mass lesions in the brain. Aim of this study was to investigate the accuracy of the CLE technique in analyzing histological patterns of different brain metastasis originated from different organs. Furthermore, we tried to find out the primary tumor according the confocal endoscopic histopathological patterns in comparison with the HE stains of the original tumor. METHODS: We used the intraoperative CLE technique to analyze different brain metastasis originated from different organs of the body. The metastatic biopsies were staining with topical application of 0.1ml acriflavine. Furthermore, we analysed with the CLE technique biopsies taking from the primary tumor of origin, and compared those with the CLE pictures generated from the brain metastasis. Reproducible and specific histomorphologic criteria were the histopathologic gold standard staining. RESULTS: We analyzed 45 brain metastasis originated from lung, prostate, different parts of the gastrointestinal tract, breast tissue, and urogenital tract. Every type of metastasis could be defined with the CLE technique. The CLE pictures showed the same histomorphological findings as in the HE staining. Furthermore, we achieved a high accuracy of the confocal image of the metastasis compared with the confocal image of the primary tumor. The differentiation and classification under CLE view of the metastasis and also the affiliation to the organ of origin was possible. CONCLUSION: With the CLE technique it is possible to characterize and define brain lesions as metastatic tumors regarding their histological confocal appearance. Furthermore, we were able to differentiate brain metastasis in vivo from each other. Because of the high accuracy of the confocal image of the metastasis when compared with the confocal image of the primary tumor this technique might be able in the future to define the organ of origin according to histomorphological architecture of the confocal image.

Neuro Oncol. 2014;16(Suppl 1):i105–i108. doi: 10.1093/neuonc/nou077.4

NS-004. NEOADJUVANT CHEMOTHERAPY FOR INFANTILE BRAIN TUMORS

Hideki Ogiwara 1, Chikako Kiyotani 2, Keita Terashima 2, Nobuhito Morota 1

Abstract

OBJECTIVE: Complete removal of infantile brain tumors is often difficult due to large size and high vascularity, while degree of resection is related to their prognosis in most cases. Neoadjuvant chemotherapy may facilitate resection by reducing the vascularity of the tumor. The effectiveness of neoadjuvant chemotherapy for management of infantile tumor was evaluated. METHODS: Retrospective review of infants who underwent tumor removal after neoadjuvant chemotherapy was performed. RESULTS: Nine patients underwent surgical resection after neoadjuvant chemotherapy. The mean age was 18 months (ranged from 2 to 50 months). The average largest diameter of the tumor was 71 mm (range from 30 to 130 mm). Five patients underwent partial resection, and 4 underwent biopsy as an initial surgery. The histopathological diagnoses were ependymoma in 2 patients, anaplastic ependymoma in 1, PNET in 2, chroidplexus carcinoma in 1, AT/RT in 1, glioblastoma in 1, and ETANTR in 1. After several courses of multiagent chemotherapy (mainly with vincristine, cyclophosphamide, etoposide, and cisplatin), the second-look surgery was performed. In one patient with PNET, intratumoral hemorrhage was observed after 2 courses of chemotherapy. The tumor volume was reduced to varying degree in 5 patients (56%) after chemotherapy. Intraoperatively, the vascularity of the tumor was considerably reduced in all cases. Gross total resection was achieved in 8 patients (89%) and near-total resection in 1 (11%). The average blood loss was 20% of the estimated blood volume, and 3 (33%) required a blood transfusion. There was no surgical mortality. One patient had transient dysphasia postoperatively. The mean follow-up period was 18 months. Two patients (22%) died (due to tumor progression in 1 and sepsis in 1), and 4 patients (44%) had no recurrence of the tumor. CONCLUSIONS: Neoadjuvant chemotherapy for infantile brain tumors was effective in reduction of tumor vascularity and facilitated subsequent surgical resection.

Neuro Oncol. 2014;16(Suppl 1):i105–i108. doi: 10.1093/neuonc/nou077.5

NS-005. SKULL BASE SURGERY PERFORMED WITH A NEW MINIATURIZED 3D CHIP ON THE TIP – MICROENDOSCOPIC DEVICE

Cleopatra Charalampaki 1, Alhadi Igressa 1

Abstract

OBJECTIVE: The goal of the performed study was to evaluate the possibility of a three dimensional endoscope to become a combined microscope-endoscope device in one. We analyzed the ergonomy of the device, the implementation into the surgical workflow, the image quality and the future perspectives such devices could have for the next generation of neurosurgeons. METHODS: Within 12 months, 32 patients (15 male, 17 female, 20-70a) underwent surgery in neuroaxis using the new 3D-microendoscope (ME). The new 3D-ME has a) the ability to visualize the surgical field from out- to inside with all advantages offered by a microscope, and in the same moment, b) its design is like a small diameter endoscope that allows stereoscopic views extracorporal, intracorporal and panoramic “para-side” of the lesion. RESULTS: In general transcranial 3D-“microendoscopy” was performed in all patients with high-resolution 3D quality. No severe complications were observed intra- or postoperatively. With the addition of depth perception, the anatomic structures were well seen and observed. CONCLUSION: The 3D-microendoscopy is a very promising surgical concept associated with new technological developments. The surgeon is able to switch to a modern visualization instrument reaching the most optimal surgical approach without compromising safety, effectiveness, and visual information.

Neuro Oncol. 2014;16(Suppl 1):i105–i108. doi: 10.1093/neuonc/nou077.6

NS-006. GIANT MENINGIOMAS OF THE ANTERIOR AND MIDDLE FOSSA: REMOVAL UNDER ENDOSCOPE-ASSISTED KEY-”BURR”-HOLE CONDITIONS VIA AN EYEBROW INCISION

Alhadi Igressa 1, Cleopatra Charalampaki 1

Abstract

OBJECTIVE: Conventional open surgery of giant meningiomas contains some special difficulties. In the present study, we retrospectively analyzed the surgical technique, and outcome in 40 patients with giant meningiomas located in the frontal fossa and partly extended into the middle fossa. All patients were treated via a keyhole craniotomy as large as necessary to host the instruments and as small as possible to achieve the best surgical result. METHODS: Within 5 years, 40 patients (12 male, 28 female) underwent surgery in the frontal and temporal base for giant meningiomas (diameter > 5cm). The mean patient age was 59 years. The follow-up period ranged from 3 to 56 months. Depending on the localization of the tumor, the skin incision was between 2.5 and 3 cm long and was made without shaving the patient's eyebrow hair. Subsequently, a key“burr“hole craniotomy was performed of approximately 0.8 x1.2 cm in diameter. RESULTS: Headache and psycho-organic syndrome were the most common presenting symptoms in all patients. Disturbances were associated in detail with psychological deterioration in 23 cases, visual disorder in 19 patients, and anosmia in 17 patients. Intraoperative complications were not existed. Postoperative 2 patients underwent emergency surgery because of an acute subdural bleeding and a pneumocephalus. Overall, 36 of 40 patients (90%) showed a good outcome to our criteria and returned long-term to their previous occupations respectively the elderly patients to their daily routine. CONCLUSION: Choosing the correct placed keyhole approach with a refinement of the classic keyhole craniotomy to a more smaller key”burr”hole approach, with the use of modern and new designed equipment it is possible to perform complex skull base procedures with the same safety, efficiency and less complication rates as described in the literature for giant meningeomas even performed with classic keyhole craniotomies.

Neuro Oncol. 2014;16(Suppl 1):i105–i108. doi: 10.1093/neuonc/nou077.7

NS-007. THALAMIC TUMOURS IN CHILDREN: EVALUATION OF SURGICAL STRATEGY

Benedetta Pettorini 1, Barry Pizer 1, Amit Kanwar 1, Shivaram Avula 1, Conor Mallucci 1

Abstract

INTRODUCTION: Indication for resection of thalamic tumours in children has always been debated, varying from a biopsy only strategy to attempt at total resection independent from radiological appearances. Generally, thalamic tumours are considered unfavourable for resection because of high morbidity rate reported and a lack of data with respect to the correlation between extent of resection and survival. In this study we reviewed our experience with thalamic tumours since 1998 to appraise our practice and surgical strategies and to determine which factors guided treatment. METHODS: Medical records and imaging studies were obtained in 17 children with thalamic tumours operated on between 1998 and 2011. Tumours arising from hypothalamus, optic pathways, pineal region, brainstem and ventricles were excluded. Age at presentation, duration and type of symptoms, radiological features, treatment received, surgical approach, follow-up and survival were recorded. Type of surgery was classified as biopsy, partial resection (<90%), subtotal resection (>90%) or total. RESULTS: The patients ranged in age from 2 to 15 (median 7.4 years). The tumours were treated by biopsy alone (stereotactically or endoscopically) in 10 cases, by biopsy followed by resection in 4 cases and resection alone in 5 cases. Partial resection was then achieved in 33% of cases, subtotal in 44% and total in 22%. The tumours were approached via a transcortical transtemporal route in 7 cases and transcallosal route in 2 cases. The tumour diagnosis was pilocytic astrocytoma 37% of cases, oligodendroglioma in 28%, astrocytoma grade II in 43%, astrocytoma grade III in 18%, glioblastoma in 6% and glioneuronal tumour in 6%. Five children suffered transient morbidity after surgery, two of them after biopsy. Two children died during follow-up. CONCLUSIONS: Recent improvement in imaging techniques and surgical tools make more aggressive surgery technically feasible and safe.

Neuro Oncol. 2014;16(Suppl 1):i105–i108. doi: 10.1093/neuonc/nou077.8

NS-008. ANOREXIA: AN EARLY SIGN OF FOURTH VENTRICLE ASTROCYTOMA IN CHILDREN

Henri-Arthur Leroy 1, Marc Baroncini 1, Isabelle Delestret 1, Matthieu Vinchon 1

Abstract

INTRODUCTION: Pediatric low-grade astrocytomas of the fourth ventricle are rare tumors, generally revealed by hydrocephalus. However, some patients present with a history of severe anorexia. It might be a harbinger, which could have led to earlier diagnostic. We decided to examine our database in order to evaluate the incidence and signification of anorexia in this context. METHODS: Retrospective monocentric study of cases of low-grade astrocytomas of the fourth ventricle operated between 1991 and 2012 in our pediatric neurosurgery unit of Lille. We particularly observed the clinical presentation and long-term clinical, oncological and radiological evolution. Non-parametrical tests were used (Mann Whitney, Fisher). RESULTS: We reviewed 34 cases, 31 pilocytic astrocytomas and 3 diffuse astrocytomas, 16 boys and 18 girls, (M/F ratio 0,89). Mean age was 8 years old. Seven presented notable anorexia, the average BMI in this group was 12,4; with clinical signs evolving for 11,5 months. 27 children had no anorexia; average BMI in this group was 17,4 p < 0,001, with clinical evolution for 6 months on average p < 0,05. We found no significant difference regarding hydrocephalus (p = 0,19) or tumor location (p = 0,63). In all children with anorexia, body mass index improved markedly in the postoperative follow-up, which lasted on average 6 years. CONCLUSION: Anorexia with stunted body weight curve is a non-exceptional presentation in children with low-grade astrocytomas of the 4rth ventricle. Unexplained or atypical anorexia with negative etiologic assessment should prompt cerebral imaging. Clinical improvement after surgical resection suggests a possible interaction between tumor tissue and appetite suppressing peptide secretion.

Neuro Oncol. 2014;16(Suppl 1):i105–i108. doi: 10.1093/neuonc/nou077.9

NS-009. MICROSCOPIC ENDONASAL TRANSSPHENOIDAL SURGERY IN CHILDREN WITH SMALL NOSTRIL

Tsutomu Kato 1

Abstract

INTRODUCTION: Recently, the endonasal transsphenoidal approach has been widely used as the standard technique for pituitary surgery instead of the sublabial approach. However, using this approach involves potential conflicts between surgical instruments when entering the nostril and while working inside even with an endoscope. In patients with small nostril, it requires an additional tension release incision to acquire sufficient working space, especially for the procedure with the speculum using the microscope because the anterior nasal spine, the medial edge of the maxillary bone crest, the nasal columella and the middle turbinate mainly limit the speculum opening. METHODS: For children whose nostrils are less than 10 mm in diameter, an additional incision is made across the base of the columella after the standard endonasal unilateral-septal approach. Disarticulation of the septal cartilage on the nasal crest of maxilla extending to the junction with the perpendicular plate of the ethmoid bone, and elevation of the nasal mucosa from both sides of the nasal floor with the septal cartilage and the incised columella, which are pushed over to the contralateral side of the nostril, allow the ostium for the speculum to spread to about 20 mm. RESULTS: This approach was used twice in a 9-year-old boy with craniopharingioma and its recurrence. The boy's nostril was 9 mm in diameter and a columellar incision allowed the ostium for the speculum to spread to 20 mm. The columellar scar, 7 years later after the second incision, is cosmetically imperceptible and acceptable to the patient without any skin problems. CONCLUSION: This report describes a simple technique, termed the “endonasal unilateral-septal midline transsphenoidal approach with columellar incision”, for children with small nostril. Although this is not a common technique of the endonasal approach, it should be considered for children with small nostril to prevent a skin laceration due to excessive speculum spreading.

Neuro Oncol. 2014;16(Suppl 1):i105–i108. doi: 10.1093/neuonc/nou077.10

NS-010. ONE MONTH MORTALITY FOLLOWING CRANIOTOMY FOR PEDIATRIC BRAIN TUMORS: OUTCOME ANALYSIS REGARDING 3,130 CHILDREN FROM SEER

Todd Hankinson 1, Roy Dudley 1, Seerat Poonia 2, Michelle Torok 2, Michael Handler 1, Arthur Liu 2

Abstract

INTRODUCTION: Thirty day mortality is increasingly becoming a reference metric regarding surgical outcomes. Recent data estimate a 1.6% rate of death within the first 30 days after neurosurgery for patients <16 years of age. However, no detailed analysis of short-term mortality rates following craniotomy for tumor in the pediatric population has been conducted. METHODS: The Surveillance, Epidemiology and End Results (SEER) database was utilized to identify patients with age <21 years who underwent subtotal or gross total resection of a primary intracranial tumor between 1973 and 2010. One month mortality was estimated by identifying patients for whom time from diagnosis to death was within one month. Standard statistical methods were used to estimate associations between independent variables and mortality. RESULTS: 3130 patients met criteria for inclusion in the analysis. The crude probability of death within 1 month of the therapeutic procedure (surgery) was 2.0%. Patients less than 1 year of age (n = 211) had a risk of death of 12.5%, while those between 1-21 year (n = 2,919) had a risk of 1.2% (p < 0.001). Patients of white race had a risk of death of 2.3%, which was higher than other races but did not demonstrate statistical significance (p = .09). No difference in outcome based on geography was identified. No significant differences were identified with analysis of death within 2 months of diagnosis when compared to death within 1 month of diagnosis. CONCLUSION: We found the crude probability of death within 1 month of craniotomy for a primary brain tumor in children to be approximately 2.0%, consistent with previous data. However, the risk of mortality in infants is considerably higher. Further investigation will be required to identify reasons underlying this finding. Neither race nor geographic location was associated with a clinically or statistically significant difference in 1 month mortality.

Neuro Oncol. 2014;16(Suppl 1):i105–i108. doi: 10.1093/neuonc/nou077.11

NS-011. TREATMENT PARADIGMS FOR SUBEPENDYMAL GIANT CELL TUMORS IN TUBERSOUS SCLEROSIS COMPLEX

David Harter 1, Matthias Karajanis 1, Jeffery Wisoff 1, Howard Weiner 1

Abstract

Subependymal Giant Cell Tumors (SEGAs) are benign intra-axial brain tumors occurring most commonly in pateints with Tuberous Sclerosis Complex (TSC). SEGAs are usually slow-growing, and cause symptoms related to obstruction of CSF pathways. Conventionally available treatment includes craniotomy for tumor removal. The elucidation of the molecular mechanisms related to SEGA formation has allowed for the development and study of inhbitors of the affected cellular pathways (mechanistic target of Rapamycin - mTOR). We review our experience with the surgical treatment of 25 patients with TSC related SEGAs (17 with craniotomy and 8 endoscopically) with respect to tumor control, complications and cost, and discuss the relative merits of surgical and/or pharmacological treatment with mTOR inhibitors.

Neuro Oncol. 2014;16(Suppl 1):i105–i108. doi: 10.1093/neuonc/nou077.12

NS-012. SURGERY OF PINEAL REGION TUMORS USING SUBOCCIPITAL SUPRACEREBELLAR APPROACH

Irakli Toidze 1, Vladimir Tsikarishvili 1, Nino Lobjanidze 1, Irma Elizbarashvili 1, Nino Akiashvili 1, Tea Maisuradze 1

Abstract

OBJECTIVES: Tumors of the pineal region account for 0.5%- 1.6 % of brain tumors. The surgical removal of pineal region tumors ranks among the most difficult neurosurgical intervention and neurosurgeons must have high skills for this type of surgery. Surgical treatment with aggressive tumor resection is the preferred method in most cases of this type of tumors. The aim of present study was the assessment of advantages of suboccipital supracerebellar approach to pineal region tumors. METHODS: We present data of 5 patients with pineal region tumors, which underwent open surgery by suboccipital supracerebellar approach. RESULTS: All patients (Mean age 10,2 years old,3 male/2 female) underwent neurosurgical intervention used suboccipital supracerebellar approach and gross total removal was achieved. MRI with contrast enhancement had been done in all patients before and after surgery, which demonstrated tumor radical removal. Pathological investigation were revealed -2 pineocytoma, 3- pineoblastoma. Before and after surgery neurological assessment revealed the following: visual and ocular movement were impaired in 3 patients, imbalance and ataxia were found in 2, but all of them were temporary. All symptoms resolved in 3 months, long-term outcome was good in all patients 3 of them completely recovered, in 2 patients revealed only neurological signs, which were not interfere in everyday life. 2 patients with pineoblastoma underwent radiation therapy. In all cases marked hydrocephalus presented before operation. In two cases third ventricle was connected with cisterna magna by shunt. In 3 patients shunt weren't needed, because of restored of cerebrospinal fluid flow.

Neuro Oncol. 2014;16(Suppl 1):i105–i108. doi: 10.1093/neuonc/nou077.13

NS-013. CHOROID PLEXUS PAPILLOMA IN CHILDREN: AN ANALYSIS OF 18 CASES

Awadhesh Jaiswal 1, Sushila Jaiswal 1, Anant Mehrotra 1, Arun Srivastava 1, Rabi Sahu 1, Sanjay Behari 1

Abstract

INTRODUCTION: Choroid plexus papilloma (CPP) is a common intraventricular tumor particularly in children. Total microsurgical excision of tumor is the treatment of choice. AIM: To study the surgical outcome of CPP. MATERIAL AND METHOD: The study was performed by the retrospectively reviewing the records of patients of CPP. RESULTS: 18 cases of CPP (11 males and 7 females) were managed over last 8 years. Age ranged from 2 months to 16 years. CPP was in lateral ventricle (14 cases), both lateral and third ventricle (3 case) and in fourth ventricle (1 case). All patients presented with features of raised intracranial pressure as predominant symptoms. Total microsurgical excision of tumor was achieved in all cases. Intraoperative EVD was put in all cases which were later removed. Postoperative VP shunts (3 cases) and subdural peritoneal shunt was done in 1 case. One patient died in post operative period due to anaesthetic complication. Follow up was available in 14 cases, ranged from 3- 28 months and all 14 cases had no recurrence. CONCLUSION: Total microsurgical excision of CPP bears good outcome.

Neuro Oncol. 2014;16(Suppl 1):i105–i108. doi: 10.1093/neuonc/nou077.14

NS-014. PAEDIATRIC MENINGIOMAS: A STUDY OF TWELVE CASES

Sushila Jaiswal 1, Awadhesh Jaiswal 1, Anant Mehrotra 1, Sanjay Behari 1

Abstract

BACKGROUND: Paediatric meningiomas are rare intracranial neoplasms representing 0.4–4.1% of the pediatric-age tumors and 1.5–1.8% of all intracranial meningiomas. OBJECTIVE: To determine clinical presentations, radiological and histopathological spectrum of paediatric meningiomas. MATERIAL AND METHODS: The study was performed by retrospective review of the medical records of the patients of pediatric meningioma, operated in our department. RESULTS: The study includes 12 cases (9 males, 3 females; age range-4-18 years) managed over 10 years. The commonest presentation was headache followed by seizures behaviour abnormality, vomiting and visual dysfunction. The duration of symptoms ranged from 0.5-36 months. The commonest location of meningioma was frontal region followed by intraventricular, temporal, posterior fossa, falco-tentorial, pterional and temporo-parietal. On CT, the tumor was isodense (1 case), hypodense (1 case) and hyperdense (5 cases). Contrast enhancement was present in all the cases. On MRI, the tumor was isointense (7 cases) and hypointense (3 cases) on T1 weighted images and was isointense (6 cases) and hyperintense (4 cases) on T2 weighted images. Tumor had enhancement on gadolinium injection. Total surgical excision was achieved in 10 cases. Histology revealed meningothelial meningioma (4 cases), transitional meningioma (4 cases), atypical meningioma (2 cases), rhabdoid meningioma (1 case) and papillary meningioma (1 case). Following surgery, radiotherapy was advised in all WHO grade II and III cases. Follow up was available in 8 cases and ranged from 8-98 months (mean-24.2 months). Recurrence was noted in 4 cases. CONCLUSIONS: Meningiomas are uncommon in the paediatric population, have male predominance and higher rate of malignant and atypical features on histology. Surgery followed by radiotherapy is the main stay of treatment. Their recurrence rate is high.

Neuro Oncol. 2014;16(Suppl 1):i105–i108. doi: 10.1093/neuonc/nou077.15

NS-015. MRI GUIDED LASER INTERSTITIAL THERMAL ABLATION FOR PEDIATRIC BRAIN TUMORS-INITIAL EXPERIENCE OF A MULTICENTER CONSORTIUM

Todd Hankinson 1, Daniel Curry 4, John Honeycutt 3, Brent O'Neill 1, Michael Handler 1, Timothy George 2

Abstract

INTRODUCTION: Since mid 2012, MRI-guided laser interstitial thermal ablation has been utilized as a novel treatment for intracranial lesions. It has been applied primarily in epilepsy patients, but experience with pediatric brain tumors is accruing. This preliminary report from a multicenter consortium evaluates its efficacy and clinical outcomes. METHODS: Four major pediatric brain tumor centers reviewed their early experience using MRI-guided laser thermal ablation in a variety of pediatric brain tumors. Patient demographics, tumor type, length of stay including ICU care, prior surgical treatments, and complications were evaluated. RESULTS: 13 children underwent 13 thermal ablation procedures. One additional procedure was aborted due to the mechanical limitations of the headframe and laser positioning. Ages ranged from 8 to 12 years. There were 10 primary tumors and 3 recurrent tumors. Twelve were low-grade glioma variants (grade I or II), and 1 was a grade III ependymoma. Length of hospital stay was 1 day in 7 patients, 2 days in 3 patients, 5 to 6 days in 2 patients, and 21 days in 1 patient. There were 4 post-operative complications, 3 worsening neurological deficits and one broken bolt device. One patient suffered a rapid tumor recurrence centered just distal to the site of ablation, requiring craniotomy 9 weeks following laser ablation. One patient has had subsequent growth of a portion of a recurrent tumor that was intentionally left untreated with laser ablation. No other patient experienced local tumor recurrence or growth. CONCLUSIONS: This report demonstrates the early effort to work collaboratively in a multicenter fashion to critically evaluate the indications, efficacy and outcome for novel therapies such as MRI-guided laser thermal ablation.

Neuro Oncol. 2014;16(Suppl 1):i105–i108. doi: 10.1093/neuonc/nou077.16

NS-016. OMMAYA RESERVOIR-RELATED INFECTIONS AND OTHER COMPLICATIONS IN PEDIATRIC PATIENTS WITH BRAIN TUMORS

Nicolas U Gerber 1, Anna Müller 1, Oliver Bozinov 2, Christoph Berger 3, Michael A Grotzer 1

Abstract

BACKGROUND: Intraventricular catheter systems with subcutaneous reservoirs, including Ommaya reservoirs (OR), are used for the administration of intraventricular chemotherapy in children with brain tumors. Little is known about the incidence of infectious or other complications in this population. OBJECTIVE: To describe the incidence and nature of infections and other complications related to OR. METHODS: Retrospective analysis of Ommaya reservoir-related complications in 591 consecutive patients with a brain tumor diagnosed between 1980 and 2011 and treated at our institution. RESULTS: 22 patients with a median age of 3.1 years (range, 1.4 - 13.9) at diagnosis received a total of 32 OR (median number per patient, 1; range 1 - 3) between 1998 and 2011. 18 complications (56%) in 12 (55%) patients were recorded. Seven patients (32% of patients, 22% of reservoirs) had a OR-related infection with coagulase-negative staphylococci, diagnosed at a median of 10 days (range, 2 - 203) after implantation: in four patients 2 - 10 days after implantation/after 0 - 1 injections, probably as a surgical complication; in three patients 51 - 66 days after implantation/after 9 - 29 injections rather as a complication of manipulation. None of the patients with infection had received a perioperative prophylaxis with intraventricular antibiotics, 4 patients had received intravenous cefazoline. Reservoirs from all infected patients were explanted, patients were treated with intravenous and/or intrathecal antibiotics: There were no long-term sequelae or deaths. Other complications included catheter misplacement, n = 3; wound dehiscence, n = 6; leakage of cerebrospinal fluid (CSF),n = 1; subcutaneous CSF collection in a patient with hydrocephalus, n = 1. With the exception of 3 devices (misplacement, n = 2; subcutaneous CSF collection, n = 1), all of them were explanted. CONCLUSION: Infections were the most frequent OR-related complication. Further research on larger collectives is needed to identify risk factors and to evaluate preventive measures such as the administration of intrathecal antibiotics.

Neuro Oncol. 2014;16(Suppl 1):i105–i108. doi: 10.1093/neuonc/nou077.17

NS-017. TRENDS IN THE TREATMENT OF PAEDIATRIC INTRACRANIAL AND CNS TUMOURS: THE EXPERIENCE IN NORTH WEST ENGLAND, 1954-2008

Ian Kamaly-Asl 1, Robert Alston 2, Martin McCabe 2, Jillian Birch 2, Rao Gattamaneni 3, Eddy Estlin 4

Abstract

INTRODUCTION: The availability of new technologies and treatments since 1954 has significantly affected the options available for the treatment of children with intracranial tumours. METHODS: Children aged 0 to 14 years diagnosed between 1954 and 2008 with an intracranial tumour in a geographically defined area of North-West England, were identified from the records of the population-based Manchester Children's Tumour Registry. Details of surgical operations, radiotherapy and chemotherapy were identified from the registry records and those of local hospitals. Vital status and dates of death for individuals not identified as dead from registry records were obtained from NHS Central Records Office. We analysed the changes in the number of operations and completeness of surgical resections over time and by age group, site and tumour morphology . Similar analyses of the utility of radiotherapy and chemotherapy were also performed. RESULTS: During the initial period (1954-1976), 10% of cases received no treatment, compared to around 4% for later cases (1977-2008). For those cases with at least one tumour-material removing operation, the success of the most radical operation increased over time (P = 0.0002), with 38% of cases in 1954-1976 having total or near-total resection, compared to 55% in 1994-2008. The numbers receiving radiotherapy increased from 51% in 1954-1976 to 63% in 1977-1993, beforedecreasing again to 49% in 1994-2008. Chemotherapy rates increased from 22% in the first period, to 39% for 1994-2008. The complexity of chemotherapy also increased, with 90% of cases in 1954-1976 with known chemotherapy courses receiving only one agent (generally vincristine), compared 1994-2008 when 28% received two agents and 57% at least three agents. CONCLUSION: The available treatments for childhood CNS tumours have changed over time, with more complete surgery possible and with more complex chemotherapy regimens possibly displacing radiotherapy.

Neuro Oncol. 2014;16(Suppl 1):i105–i108. doi: 10.1093/neuonc/nou077.18

NS-018. TRACTOGRAPHY AND NEURONAVIGATION:A NEW IMPORTANT TOOL FOR OPTIMIZING BRAIN LESIONS RESECTION?

Giselle Coelho 1, Filipe Kunsler 2, Lucas Lessa 3, Sidnei Epelman 1, Nelci Zanon 2

Abstract

INTRODUCTION: Diffusion tensor imaging (DTI) is a promising, noninvasive magnetic resonance imaging (MRI) method for studying the anatomical organization of major white matter fiber systems. A topic, which currently is receiving increased attention, is the application of DTI fiber tracking in the investigation of patients with intracranial tumors. Therefore, has been used in neuronavigation systems, allowing the correct and precise tumoral identification and,consequently, safe resection. METHODS: Structural magnetic resonance imaging, and diffusion tensor imaging were performed on 12 patients before they underwent lesion resection using neuronavigation. 11 patients presented brain tumors and six of them were localized in posterior fossa. One case,the diagnostic of the supratentorial lesion was brain abscess. The clinical feasibility of this approach was evaluated in 12 cases of lesion resection. In addition, system performance was evaluated by measuring the latency between surgical tool tracking and visualization of the white matter tracts. RESULTS: Lesion resection was performed successfully in all 12 patients. The seeded white mater tracts close to the lesion and other critical structures, as defined by the structural images, were interactively visualized during the intervention to determine their spatial relationships relative to the lesion and critical deep cortical areas. CONCLUSION: Tractography can be used combined with neuronavigation for guiding resection of tumors. Even more important, this serie shows why tumor resection surgery based on tractography mapping may sometimes lead to better clinical outcomes (mainly in low grade gliomas) even though in posterior fossa, without presenting notable brain shift.

Articles from Neuro-Oncology are provided here courtesy of Society for Neuro-Oncology and Oxford University Press

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