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Journal of Neurosurgery. Pediatrics Oct 2014Low-grade glial and glioneuronal brain tumors are frequently encountered in the pediatric population and can be effectively treated by resection. The authors aimed to...
OBJECT
Low-grade glial and glioneuronal brain tumors are frequently encountered in the pediatric population and can be effectively treated by resection. The authors aimed to use imaging to evaluate how often tumors recurred and to determine if recurrences were associated with any clinical symptoms, along with the financial costs of imaging, in patients with radiographically proven gross-total resection (GTR) at Boston Children's Hospital. These data were assessed to propose guidelines regarding postoperative surveillance.
METHODS
The authors performed a retrospective cohort analysis of the Pediatric Brain Tumor Program database from 1993 to 2003 to identify patients with glial or glioneuronal tumors initially evaluated at Boston Children's Hospital. Among the 888 patients evaluated for any type of brain tumor during this period, 67 patients had WHO Grade I glial or glioneuronal lesions with radiographically proven GTR and available follow-up data. The frequency and timing of postoperative imaging was compared with the institutional protocol. Recurrence-free survival was calculated using the Kaplan-Meier method. Financial costs of imaging were available from 2001 to 2009 and were averaged to extrapolate the postoperative surveillance costs.
RESULTS
Among the 67 patients with GTR, 13 recurrences were detected radiographically with a mean time to recurrence of 32.4 months (range 2.9-128.5 months). The mean duration of follow-up after surgery was 6.6 years. The recurrence-free survival at 2 and 5 years after GTR for all low-grade glial and glioneuronal tumors was 0.90 (95% CI 0.82-0.97) and 0.82 (95% CI 0.73-0.92), respectively. No clinical symptoms were associated with any of the recurrences, and no deaths occurred. Under the institutional protocol of surveillance imaging, the estimated cost per recurrence at 5 years was $104,094 per patient. The proposed protocol would reduce the number of MR scans in the first 5 years from 10 to 5, providing a potential cost savings of $52,047 per recurrence.
CONCLUSIONS
Given the slow-growing, clinically asymptomatic nature of low-grade glial and glioneuronal tumors coupled with the financial and psychological costs of repeated imaging, the authors propose a postoperative surveillance MRI schedule that is less intensive than current institutional practice.
Topics: Adolescent; Boston; Brain Neoplasms; Child; Child, Preschool; Disease-Free Survival; Female; Follow-Up Studies; Humans; Infant; Kaplan-Meier Estimate; Male; Neoplasm Grading; Neoplasm Recurrence, Local; Neuroimaging; Postoperative Period; Retrospective Studies; Time Factors; Young Adult
PubMed: 25062303
DOI: 10.3171/2014.6.PEDS1321 -
Journal of Visualized Experiments : JoVE Nov 2015Brain tumors are a major cause of cancer-related morbidity and mortality. Developing new therapeutics for these cancers is difficult, as many of these tumors are not...
Brain tumors are a major cause of cancer-related morbidity and mortality. Developing new therapeutics for these cancers is difficult, as many of these tumors are not easily grown in standard culture conditions. Neurosphere cultures under serum-free conditions and orthotopic xenografts have expanded the range of tumors that can be maintained. However, many types of brain tumors remain difficult to propagate or study. This is particularly true for pediatric brain tumors such as pilocytic astrocytomas and medulloblastomas. This protocol describes a system that allows primary human brain tumors to be grown in culture. This quantitative assay can be used to investigate the effect of microenvironment on tumor growth, and to test new drug therapies. This protocol describes a system where fluorescently labeled brain tumor cells are grown on an organotypic brain slice from a juvenile mouse. The response of tumor cells to drug treatments can be studied in this assay, by analyzing changes in the number of cells on the slice over time. In addition, this system can address the nature of the microenvironment that normally fosters growth of brain tumors. This brain tumor organotypic slice co-culture assay provides a propitious system for testing new drugs on human tumor cells within a brain microenvironment.
Topics: Animals; Astrocytoma; Brain Neoplasms; Coculture Techniques; Fluorescent Dyes; Mice; Microscopy, Fluorescence; Microspheres; Organ Culture Techniques; Tumor Microenvironment
PubMed: 26575352
DOI: 10.3791/53304 -
BMJ Case Reports Apr 2024
Topics: Humans; Infant, Newborn; Astrocytoma; Brain; Brain Neoplasms; Magnetic Resonance Imaging
PubMed: 38649241
DOI: 10.1136/bcr-2024-260174 -
JBJS Case Connector 2020A 16-year-old male patient with severe kyphoscoliosis, paraplegia, and neurogenic bowel/bladder caused by a juvenile pilocytic astrocytoma was treated surgically using a...
CASE
A 16-year-old male patient with severe kyphoscoliosis, paraplegia, and neurogenic bowel/bladder caused by a juvenile pilocytic astrocytoma was treated surgically using a hybrid fusion construct with polyethylene bands after neoplasm resection. Owing to the necessity of serial postoperative magnetic resonance imaging studies to evaluate the recurrence of pathology and known effect of metal artifact from spinal instrumentation, preservation of radiographic resolution was critical.
CONCLUSION
We describe the novel utility of polyethylene bands placed around the ribs as a safe and effective form of hybrid construct for reducing radiographic metal artifact in spinal deformity cases requiring serial imaging.
Topics: Adolescent; Astrocytoma; Humans; Magnetic Resonance Imaging; Male; Scoliosis; Spinal Cord Neoplasms; Spinal Fusion
PubMed: 32224656
DOI: 10.2106/JBJS.CC.19.00351 -
Cureus Oct 2018Hyponatremia post-neurosurgical intervention can be dangerous and potentially life-threatening. Two of its most common causes are cerebral salt wasting (CSW) and...
Hyponatremia post-neurosurgical intervention can be dangerous and potentially life-threatening. Two of its most common causes are cerebral salt wasting (CSW) and syndrome of inappropriate anti-diuretic hormone release (SIADH). CSW is proposed to be secondary not only to the elevated levels of circulating atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) but inhibition of steroidogenesis in the zona glomerulosa of the adrenal cortex, thus resulting in mineralocorticoid deficiency. We present a two-year-old male who had developed acute hyponatremia secondary to CSW on post-operative day two after a sub-total resection of a low-grade juvenile pilocytic astrocytoma (WHO grade I). Fludrocortisone was successfully used to manage the refractory hyponatremia and alleviated the need to use very large amounts of oral sodium supplementation.
PubMed: 30648045
DOI: 10.7759/cureus.3505 -
BMJ Case Reports Feb 2019
Topics: Astrocytoma; Brain Neoplasms; Female; High-Throughput Nucleotide Sequencing; Humans; Mutation, Missense; Proto-Oncogene Proteins p21(ras); Sequence Analysis, DNA; Young Adult
PubMed: 30798277
DOI: 10.1136/bcr-2018-228128 -
Journal of Pediatric Hematology/oncology Aug 2015Juvenile pilocytic astrocytoma, the most common pediatric central nervous system (CNS) neoplasm, characteristically displays an indolent growth pattern and rarely...
Juvenile pilocytic astrocytoma, the most common pediatric central nervous system (CNS) neoplasm, characteristically displays an indolent growth pattern and rarely demonstrates metastatic dissemination. Reports of infections mimicking CNS metastatic disease are also rare and can impact treatment. We report the youngest known case of a child with a CNS Nocardia farcinica infection who had a known cerebellar pilocytic astrocytoma, review other infections that may masquerade as CNS neoplasms, and discuss N. farcinica CNS infections.
Topics: Astrocytoma; Brain Neoplasms; Cerebellar Neoplasms; Child, Preschool; Diagnosis, Differential; Humans; Male; Meningeal Neoplasms; Meningitis; Nocardia; Nocardia Infections; Prognosis
PubMed: 26181420
DOI: 10.1097/MPH.0000000000000360 -
Journal of Clinical Neuroscience :... Mar 2016Optic nerve gliomas (ONG) are rare and seldom encountered in clinical practice. The pilocytic (astrocytoma) variant of ONG almost always presents during the first two...
Optic nerve gliomas (ONG) are rare and seldom encountered in clinical practice. The pilocytic (astrocytoma) variant of ONG almost always presents during the first two decades of life. In this report, the authors discuss an unusual presentation of pilocytic astrocytoma of the juvenile type in an elderly Indian male. With this unusual presentation, ONG affecting the visual pathway should be considered as a possible differential of visual diminution in the elderly population.
Topics: Aged; Astrocytoma; Humans; Male; Optic Nerve Glioma; Vision Disorders
PubMed: 26549677
DOI: 10.1016/j.jocn.2015.05.060 -
BMJ Case Reports Dec 2016
Topics: Astrocytoma; Cerebellar Neoplasms; Cerebellum; Child; Computed Tomography Angiography; Cranial Fossa, Posterior; Fatal Outcome; Humans; Intracranial Aneurysm; Magnetic Resonance Imaging; Male; Subarachnoid Hemorrhage
PubMed: 27927709
DOI: 10.1136/bcr-2016-217583 -
Pediatric Neurology Sep 2015
Topics: Astrocytoma; Brain; Brain Neoplasms; Cerebellar Diseases; Child, Preschool; Diagnosis, Differential; Humans; Magnetic Resonance Imaging; Male; Mutism
PubMed: 26145481
DOI: 10.1016/j.pediatrneurol.2015.06.001