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Due-Tønnessen BJ, Lundar T, Egge A, Scheie D. Neurosurgical treatment of low-grade cerebellar astrocytoma in children and adolescents: a single consecutive institutional series of 100 patients. J Neurosurg Pediatr 2013; 11:245-9. [PMID: 23240848 DOI: 10.3171/2012.11.peds12265] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT The objective of this study was to delineate the long-term results of surgical treatment of pediatric low-grade cerebellar astrocytoma. METHODS One hundred consecutive children and adolescents (0-19 years old) who underwent primary tumor resection for a low-grade cerebellar astrocytoma during the years 1980-2011 were included in this retrospective study on surgical morbidity, mortality rate, academic achievement, and/or work participation. Gross motor function and activities of daily living were scored according to the Barthel Index. RESULTS Of the 100 patients, 61 children were in the 1st decade, and 39 were 10-19 years old. The male/female ratio was 1.13:1 (53 males, 47 females). No patients were lost to follow-up. There were no deaths in this series and all 100 patients are currently alive. In 29 patients, the follow-up duration was less than 10 years, in 37 it was between 10 and 19 years, and in 34 it was between 20 and 31 years. The Barthel Index was 100 (normal) in 97 patients, 90 in 2 patients, and 40 in the last patient. A total of 113 tumor resections were performed. Two patients underwent further tumor resection due to MRI-confirmed residual tumor demonstrated on the immediate postoperative MR image (obtained the day after the initial procedure). Furthermore, 9 children underwent repeat tumor resection after MRI-confirmed progressive tumor recurrence up to 10 years after the initial operation. Two of these patients also underwent a third resection, without subsequent radiation therapy, and have experienced 8 and 12 years of tumor-free follow-up thereafter, respectively. A total of 15% of the patients required treatment for persistent hydrocephalus. CONCLUSIONS Low-grade cerebellar astrocytoma is a surgical disease, in need of long-term follow-up, but with excellent long-term results. Nine percent of the children in this study underwent repeated surgery due to progressive tumor recurrence, and 15% were treated for persistent hydrocephalus.
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Matsumoto J, Kochi M, Morioka M, Nakamura H, Makino K, Hamada JI, Kuratsu JI, Ushio Y. A long-term ventricular drainage for patients with germ cell tumors or medulloblastoma. ACTA ACUST UNITED AC 2006; 65:74-80; discussion 80. [PMID: 16378864 DOI: 10.1016/j.surneu.2005.04.036] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2004] [Accepted: 04/04/2005] [Indexed: 11/19/2022]
Abstract
BACKGROUND Hydrocephalus associated with intracranial germ cell tumors or disseminated medulloblastoma has been treated with ventriculoperitoneal shunt. However, this procedure has a potential risk of intraperitoneal metastasis of these brain tumors. To prevent this potential risk and to minimize the risk of infection, we developed a percutaneous long-tunneled ventricular drainage (PLTVD). To confirm the effectiveness, we retrospectively analyzed the results of this procedure. METHODS From 1979 to 2003, we have treated 96 patients with germ cell tumors and medulloblastoma in our hospital. Of 96 patients, 59 (germ cell tumor, 31; medulloblastoma, 28) had hydrocephalus and 13 needed long-term cerebrospinal fluid drainage to manage the obstructive hydrocephalus due to persistent tumor or communicating hydrocephalus due to dissemination. We performed PLTVD for these cases using a flow-controlled shunt device and percutaneous long-tunneled shunt tube (peritoneal catheter) exiting at the upper abdomen and connecting to a closed drainage system. The occurrence of extraneural metastasis and the incidence of infection were evaluated. RESULTS The average duration of drainage was 74 days (range, 34-115 days). All 13 cases received full-dose chemotherapy and radiotherapy without infectious complications or extraneural metastasis. CONCLUSIONS Percutaneous long-tunneled ventricular drainage was an effective method to manage long-lasting obstructive or communicating hydrocephalus with germ cell tumors and medulloblastoma.
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Affiliation(s)
- Jun Matsumoto
- Department of Neurosurgery, Kumamoto University School of Medicine, Kumamoto 860-8556, Japan.
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Spagnoli D, Tomei G, Ceccarelli G, Grimoldi N, Lanterna A, Bello L, Sinisi MM, De Santis A, Villani RM. Combined treatment of fourth ventricle ependymomas: report of 26 cases. SURGICAL NEUROLOGY 2000; 54:19-26; discussion 26. [PMID: 11024503 DOI: 10.1016/s0090-3019(00)00272-x] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND This study investigated the relevance of prognostic factors and the impact of histological features in posterior fossa ependymoma. METHODS The charts of 26 patients (aged 1-59 years, mean 20.6 years; 11 adults) with posterior fossa ependymoma operated on between January 1983 and December 1994 were reviewed and patients followed up (mean: 93 months). RESULTS Gross total resection was performed in 18 patients (69%), subtotal in seven patients (27%), biopsy in one patient (4%). One patient (3.8%) developed respiratory complications and died. All patients underwent posterior fossa radiotherapy (5000 cGy) after surgery. Four children first received chemotherapy and then radiotherapy only when at least 3 years old. Eleven patients (42%) received radiotherapy and subsequently chemotherapy. The 5-year survival rate was 90% for adults and 40% for children (</= 6 years). CONCLUSIONS This review suggests that a) younger patients (</= 6 years), despite multimodality treatment, have a poor prognosis; b) the microanatomical location of the tumor (lateral recess, roof, and floor) influences the extent of tumor removal (p < 0.05); c) longer survivals are associated with complete removal (p < 0.05); d) the histological feature most often related to a poor prognosis is a high mitotic index (p < 0.05), whereas vascular proliferation (p = 0.149), necrosis (p = 0.215), nuclear atypia (p = 0.384) and high cellularity (p = 0.786) do not affect survival; e) histological classification (WHO) does not reflect different survival rates between ependymomas and anaplastic ependymomas (p = 0.082).
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Affiliation(s)
- D Spagnoli
- Institute of Neurosurgery, University of Milan, Ospedale Maggiore Policlinico I.R.C.C.S., Milan, Italy
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Pencalet P, Maixner W, Sainte-Rose C, Lellouch-Tubiana A, Cinalli G, Zerah M, Pierre-Kahn A, Hoppe-Hirsch E, Bourgeois M, Renier D. Benign cerebellar astrocytomas in children. J Neurosurg 1999; 90:265-73. [PMID: 9950497 DOI: 10.3171/jns.1999.90.2.0265] [Citation(s) in RCA: 114] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECT Cerebellar astrocytomas are benign tumors of childhood known to be associated with excellent long-term survival in patients in whom complete surgical resection is possible. However, the roles of other factors--clinical, radiological, histological, and therapeutic--in the survival of the patient, tumor recurrence, and long-term patient outcome remain imprecise. The goal of this study was to examine these factors and their relationships. METHODS To clarify these issues a retrospective review was conducted of 168 children who were surgically treated for a cerebellar astrocytoma at Hôpital Necker-Enfants Malades between 1955 and 1995. These patients' clinical files were examined, the histological characteristics of their tumors were reviewed, and their outcomes were assessed according to Bloom's scale and the Wechsler intelligence quotient test. Of the 168 patients in the study, 91 were male and 77 were female with a mean age of 6.9 years and a mean follow up lasting 7.7 years. Tumors were identified as being strictly located in the cerebellum in 76.2% of the patients and as involving the brainstem (referred to as the "transitional form") in 23.8% of the patients. Complete surgical excision was possible in 88.7% of cases. There was a total mortality rate of 4.2% and a tumor recurrence rate of 9.5%. Fifty-eight percent of the patients had no neurological sequelae at follow-up evaluation. Pejorative factors that were discovered by multivariate analysis to be important included: a long preoperative duration of symptoms and the transitional form of tumor with respect to survival; incomplete tumor excision with respect to an increased risk of recurrence; and a long preoperative duration of symptoms, an early epoch during which surgery was performed (1955-1974), severe ventricular dilation, and the transitional form of tumor with respect to a poorer long-term patient outcome. CONCLUSIONS The presence of brainstem involvement (tumor in the transitional form) emerged as a significant negative prognostic factor and should be treated as a distinct nosological entity. The extent of surgical excision has a significant bearing on the risk of tumor recurrence.
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Affiliation(s)
- P Pencalet
- Department of Pediatric Neurosurgery, Hôpital Necker-Enfants Malades, Paris, France
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Morreale VM, Ebersold MJ, Quast LM, Parisi JE. Cerebellar astrocytoma: experience with 54 cases surgically treated at the Mayo Clinic, Rochester, Minnesota, from 1978 to 1990. J Neurosurg 1997; 87:257-61. [PMID: 9254090 DOI: 10.3171/jns.1997.87.2.0257] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
A comprehensive review of the literature has shown that the treatment of choice for cerebellar astrocytomas has primarily been gross-total resection of the mass and gross-total resection of the enhancing portion of pilocytic astrocytomas. Most large scale studies of postresection survival rates of patients with cerebellar astrocytomas were conducted when computerized tomography (CT) and magnetic resonance (MR) imaging were not readily available. It has been shown that postoperative CT scans or MR images are more reliable than the surgeon's estimate of the degree of tumor resection at the time of surgery. It is not possible, therefore, to make an accurate determination regarding a postresection prognosis based on the degree of suspected tumor resection without the availability of appropriate radiographic imaging. In this study, the authors retrospectively evaluated the treatment of 54 patients with cerebellar astrocytoma who underwent surgery at the Mayo Clinic in Rochester, Minnesota, from 1978 through 1990. Preoperative and postoperative CT scans or MR images were available in all 54 patients.
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Affiliation(s)
- V M Morreale
- Department of Neurologic Surgery, Mayo Graduate School of Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA
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Carrie C, Mottolese C, Bouffet E, Negrier S, Bachelot TH, Lasset C, Helfre S, Guyotat J, Lapras CL, Brunat-Mentigny M. Non-metastatic childhood ependymomas. Radiother Oncol 1995; 36:101-6. [PMID: 7501807 DOI: 10.1016/0167-8140(95)01605-g] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
PURPOSE Intracranial ependymomas of childhood are relatively infrequent. There are significant disagreements concerning optimal postoperative treatment as well as the patterns of relapse following treatment. The purpose of this retrospective study was the analysis of the recurrence pattern and therefore the implication on the extent of the radiotherapy fields. Data from 37 patients referred within 19 years were used for this study. PATIENTS AND METHODS From April 1975 to July 1993, 37 children aged 1-14 years were referred for postoperative treatment of an intracranial ependymoma. Twenty-eight children received postoperative radiation therapy and 26 patients received chemotherapy. The median follow-up is 6 years (range 2 months to 19 years). RESULTS Overall survival and event free survival at 5 and 10 years were 40%. Eighteen children relapsed. Relapses occurred from 1.5 months to 3.6 years post treatment. Relapses were distant in four cases and local in 14. Age, sex, extent of primary resection, chemotherapy and type of radiation therapy did not influence the outcome. Children with poorly differentiated tumors who did not receive postoperative radiation therapy had a higher relapse rate but this difference is not statistically significant. CONCLUSIONS Despite doses of radiation > or = 50 Gy the majority of recurrences were local. Our results, despite the small number of patients are in accordance to those previously published, suggest that prophylactic craniospinal irradiation is superfluous. Better means of achieved local control are required, such as three-dimensional conformal radiation therapy with dose-escalation study or hyperfractionation regimen.
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Affiliation(s)
- C Carrie
- Department of Radiotherapy-Oncology, Centre Léon Bérard, Lyon, France
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Abdollahzadeh M, Hoffman HJ, Blazer SI, Becker LE, Humphreys RP, Drake JM, Rutka JT. Benign cerebellar astrocytoma in childhood: experience at the Hospital for Sick Children 1980-1992. Childs Nerv Syst 1994; 10:380-3. [PMID: 7842424 DOI: 10.1007/bf00335126] [Citation(s) in RCA: 50] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Between 1 January 1980, and 31 December 1992, 66 patients with cerebellar astrocytoma were diagnosed and treated at The Hospital for Sick Children in Toronto. These patients ranged in age between 1 and 18 years, with a mean age of 7.3 years. Thirty-eight patients were male and 28 were female. Total removal was possible in 61 patients and no recurrence occurred in these 61 patients. In the 5 patients in whom an incomplete resection was carried out, regrowth occurred between 1 and 8 years following resection.
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Affiliation(s)
- M Abdollahzadeh
- Division of Neurosurgery, Hospital for Sick Children, Toronto, Ontario, Canada
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Ferrante L, Mastronardi L, Schettini G, Lunardi P, Fortuna A. Fourth ventricle ependymomas. A study of 20 cases with survival analysis. Acta Neurochir (Wien) 1994; 131:67-74. [PMID: 7709787 DOI: 10.1007/bf01401455] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Twenty patients with fourth ventricle ependymoma were treated surgically at our Neurosurgery Division between January 1976 and December 1990. Ependymoblastomas and mixed gliomas operated on in the same period have not been considered. A statistical analysis of our cases and a review of the largest published series show that favourable prognostic factors are: age over 16, post-operative radiotherapy to the posterior cranial fossa and a good Karnofsky performance status (KPS) after operation. The 5-year survival rate of patients under 16 was 20%, in comparison with 60% of adults (p = 0.013). Post-operative radiotherapy to the posterior cranial fossa improved the survival markedly (5-year survival rate 68%, versus 18% without treatment; p = 0.011). The differences of survival are also significant according to a multivariate analysis (p = 0.038). Patients with a post-operative KPS over 70 had a 5-year survival rate of 61% as against 17% of the group with a worse clinical condition (p = 0.032); the multivariate analysis confirmed also that this difference was significant (p = 0.046). Pre-operative symptoms and signs, and KPS, histological grade and extent of surgical removal seem to influence the prognosis, even if the differences of survival are not statistically significant. The statistical relevance of postoperative residual tumour on CT or MRI was brought out on multivariate analysis (p = 0.044).
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Affiliation(s)
- L Ferrante
- Department of Neurological Sciences-Neurosurgery, University of Rome La Sapienza, Italy
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Voth D, Schwarz M, Geissler M. Surgical treatment of posterior fossa tumors in infancy and childhood: techniques and results. Neurosurg Rev 1993; 16:135-43. [PMID: 8345907 DOI: 10.1007/bf00258246] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
In a collective of 72 children with tumors of the posterior fossa, the preoperative diagnosis, operation planning and performance, and use of additional procedures, like the preliminary ventricular drainage and interventriculostomy are described. The extent of intra- and postoperative complications is given. Postoperative lethality was 0% in the group operated on between 1979 and 1991. The responsible factors are discussed. The findings support the opinion of ALBRIGHT (1989) that the prognosis for such patients is most promising in the hands of a specialist in pediatric neurosurgery.
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Affiliation(s)
- D Voth
- Neurosurgical Clinic, Johannes Gutenberg-University, Mainz, Fed. Rep. of Germany
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Taylor WA, Todd NV, Leighton SE. CSF drainage in patients with posterior fossa tumours. Acta Neurochir (Wien) 1992; 117:1-6. [PMID: 1514423 DOI: 10.1007/bf01400627] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The management of hydrocephalus secondary to a posterior fossa tumour is controversial. We audited recent practice with a retrospective analysis of 287 consecutive patients undergoing posterior fossa exploration for tumour. 85 shunts and 112 external ventricular drains (EVD) were placed. The overall CNS infection rate in the series was 6%. There was a significantly higher (p less than 0.01) infection rate in patients who had a drainage procedure, and a trend towards higher infection rates in patients with two drainage procedures. Early infection rates with EVDs and shunts were the same (7%). One third of patients with hydrocephalus had pre-operative drainage, a third had per-operative drainage but only a quarter required a permanent shunt. The majority of patients will not require a permanent shunt and where temporary CSF diversion is required EVD is reasonable.
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Affiliation(s)
- W A Taylor
- Department of Neurosurgery, Southern General Hospital, Glasgow, Scotland, U.K
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Vanuytsel LJ, Bessell EM, Ashley SE, Bloom HJ, Brada M. Intracranial ependymoma: long-term results of a policy of surgery and radiotherapy. Int J Radiat Oncol Biol Phys 1992; 23:313-9. [PMID: 1587752 DOI: 10.1016/0360-3016(92)90747-6] [Citation(s) in RCA: 123] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Ninety-three patients with primary intracranial ependymoma were treated at the Royal Marsden Hospital, between 1952 and 1988, with postoperative radiotherapy. The survival probability at 5, 10, and 15 years was 51%, 42% and 31%, respectively, and the corresponding progression free survival (PFS) probability, 41%, 38%, and 30%. Tumor grade was the single most important prognostic factor for survival and PFS with gender of lesser prognostic significance. Treatment parameters were stratified for grade. In patients with low grade tumors survival and PFS were better following complete macroscopic excision compared to incomplete surgery. The extent of resection had no significant influence on survival or PFS in patients with high grade tumors. Extent of irradiation did not influence PFS, irrespective of tumor grade, while patients with high grade tumors had marginally better survival following extensive irradiation compared to more limited radiotherapy. The main problem in the treatment of ependymoma remains local progression which was the cause of death in all but two patients. New treatment strategies should focus on improvement of local control, especially in incompletely resected low grade tumors and all high grade tumors. The use of spinal irradiation is unlikely to significantly improve treatment results.
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Affiliation(s)
- L J Vanuytsel
- Neuro-oncology Unit, Royal Marsden Hospital, Sutton, Surrey, UK
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Poch Puig J, Bosch Blancafort J, Nogués Bara P, Rubio García E, Sánchez de Toledo J. Hidrocefalia en los tumores de fosa posterior en la infancia. ¿Necesidad de derivación permanente de líquido cefalorraquídeo? Neurocirugia (Astur) 1992. [DOI: 10.1016/s1130-1473(92)70885-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Ernestus RI, Wilcke O, Schröder R. Supratentorial ependymomas in childhood: clinicopathological findings and prognosis. Acta Neurochir (Wien) 1991; 111:96-102. [PMID: 1950695 DOI: 10.1007/bf01400495] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Out of 29 supratentorial ependymomas in children under 10 years of age, operated on between 1951 and 1989, 18 were situated in the hemispheres and 11 in the midline. 15 of the 18 hemispheric tumours, but only 4 of the 11 intra- or paraventricular ependymomas allowed complete removal. The operative mortality within the observation period of nearly 40 years was 27% for tumours in the midline and 11% for those in the hemispheres. The grade of malignancy rose with increasing distance from the ventricular level. 5-year survival without recurrence was 75% in grade 2 and 31% in grade 3 ependymomas. The total rate of recurrence was 58%. New tumour growth can be delayed by postoperative irradiation, at least in grade 2 ependymomas. It can be prevented, if at all, only by total resection of the primary tumour.
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Affiliation(s)
- R I Ernestus
- Department of Neurosurgery, University of Cologne, Federal Republic of Germany
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Tamura M, Ono N, Kurihara H, Ohye C, Miyazaki M. Adjunctive treatment for recurrent childhood ependymoma of the IV ventricle: chemotherapy with CDDP and MCNU. Childs Nerv Syst 1990; 6:186-9. [PMID: 2383872 DOI: 10.1007/bf01850968] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The prognosis of recurrent IV-ventricle ependymoma in children is poor. Three cases of recurrent ependymoma were treated with combination chemotherapy using cis-diamine dichloro platinum (II) (CDDP) and methyl-6-(3-(2-chloroethyl)-3-nitrosoureido)-6-deoxy-alpha-D-glucopyrano side (MCNU). The patients were 2-, 3-, and 6-year-old boys. The interval between the first operation with irradiation and recurrence was 1 year and 5 months to 2 years. Two cases showed a recurrence at the original site; in the other case, a right sylvian tumor deposit was found via computed tomography. The therapeutic regiment for recurrent ependymomas was as follows: (1) the tumor was debulked if possible; (2) additional local irradiation of 30 Gy was administered; (3) combined treatment of 100 mg/m2 CDDP and 80 mg/m2 MCNU over 24 h was given 5 times with an interval of 6 weeks between treatments. The patients tolerated the therapy well with only mild side effects. Remission lasted 1 year in two patients and has lasted for 8 months in one.
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Affiliation(s)
- M Tamura
- Department of Neurosurgery, Gunma University School of Medicine, Maebashi, Japan
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Abstract
During a 20-year period (1964-1983), the authors managed 60 children with intracranial ependymomas. In 37 patients the tumors were located in the posterior cranial fossa, and in the remaining 23 they were supratentorial. The histological examination in 26 children revealed ependymoblastomas. The average duration of the clinical evolution was 4 months and 5 days in the supratentorial neoplasms and 3 months and 6 days in the subtentorial. Besides the intracranial hypertension, present in about 80% of the patients, specific localizing signs were seen in 70% of the children with subtentorial and in 40% of those with supratentorial tumors. Because of the growth pattern in posterior fossa ependymomas and despite the prevalence of histologically benign neoplasms, radical resection was accomplished in only 21.6% of the cases, as compared with 30.4% in supratentorial tumors. The postoperative mortality remains high: 29.7% in subtentorial tumors and 17.4% in supratentorial. The 1-year survival rate in subtentorial neoplasms was 70.3%, the 3-year survival 29.7%, and the 5-year survival 16.2%. The corresponding figures for supratentorial ependymomas more favorable: 82.6%, 43.5%, and 26.1%, respectively. The most important factors for improving the outcome at the present time appear to be as radical a resection as possible, supplemented with postoperative radiotherapy and chemotherapy.
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Affiliation(s)
- S Undjian
- Department of Neurosurgery, Medical Academy, Sofia, Bulgaria
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Kehler U, Arnold H, Müller H. Long-term follow-up of infratentorial pilocytic astrocytomas. Neurosurg Rev 1990; 13:315-20. [PMID: 2280843 DOI: 10.1007/bf00346373] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
We present the data of 99 patients operated on for infratentorial pilocytic astrocytoma from 1955 to 1980 at the Neurosurgical Department of the University of Hamburg/West Germany. Twenty-two patients had died. From 56 patients long-term follow-up was obtained. A comparison was done for patients either operated on until 1969 or since 1970, the time when microscopes had been introduced into the operation theatre. The mortality rate clearly dropped with the beginning of the "microsurgical era", certainly due to other improvements as well, e. g. neurosurgical intensive care. The drop in mortality was not accompanied by an improvement in outcome. Future perspectives of possibly further improving the therapy of pilocytic astrocytomas are outlined.
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Affiliation(s)
- U Kehler
- Department of Neurosurgery, Medical University, Lübeck, West Germany
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Rappaport ZH, Shalit MN. Perioperative external ventricular drainage in obstructive hydrocephalus secondary to infratentorial brain tumours. Acta Neurochir (Wien) 1989; 96:118-21. [PMID: 2711895 DOI: 10.1007/bf01456169] [Citation(s) in RCA: 58] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Of 148 patients with infratentorial brain tumours which were operated upon during a 5 year period, 59 patients had associated obstructive hydrocephalus, as evidenced by preoperative CT scan. External ventricular drainage was performed in these cases at time of surgery. CSF drainage was continued in the postoperative period for a mean of 2.3 (+/- 1.6) days. Only 6 of these 59 patients (10%) required a subsequent indwelling shunt. The infection rate was 10% and the total mortality was 8%. Perioperative ventricular drainage during and following the removal of posterior fossa tumours causing hydrocephalus provides an effective alternative to the preoperative placement of an indwelling shunt. Problems of shunt dysfunction, tumour seeding and upward herniation are thereby avoided. Postoperative ICP monitoring and drainage of blood and debris laden CSF is performed, increasing the safety of the postoperative period and possibly reducing the incidence of aseptic meningitis and postoperative shunt requirement.
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Affiliation(s)
- Z H Rappaport
- Department of Neurosurgery, Hadassah University Hospital, Jerusalem, Israel
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Abstract
According to the grading of brain tumors as proposed by the WHO in 1976, out of 128 ependymomas 83 tumors could be classified as grade II and 38 as grade III Only seven subependymomas were benign and could be assigned to grade I. In contrast to most series known from the literature, 73 ependymomas were located above the tentorium and only 55 in the posterior cranial fossa. The grade of malignancy rised with an increased distance from the ventricular level. Macroscopically complete exstirpations were usually possible in hemispheric ependymomas, whereas tumors arising from the floor of the fourth ventricle often allowed only a partial removal. The operative mortality in the infratentorial group was more than twice as that in the supratentorial group. Postoperative survival was predominantly dependent on the histologic grade of malignancy. The five year survival rate without recurrence was 57.4% in grade II ependymomas as compared to 24.1% in grade III ependymomas. It could be improved by postoperative radiation therapy in both groups of malignancy. The almost identical longterm results indicate that even in less malignant ependymomas new tumor growth will occur later on.
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Affiliation(s)
- R I Ernestus
- Department of Neurosurgery, University of Cologne, West Germany
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