Intracranial metastasis of neuroblastoma: in two different areas at the same time

Intracranial Metastases Tend to Be Overt and Predict Poor Prognosis in Children With Neuroblastoma

Background: Neuroblastoma (NB) is the most common pediatric extracranial solid neoplasm after leukemia. Intracranial metastases (IM) rarely occur in patients with NB. The present study aimed to review the clinical characteristics of NB patients from a single center presenting with IM. Methods: Two hundred children (aged 3-91 months) with NB admitted to the Fourth Affiliated Hospital of China Medical University between January 2009 and December 2015 were enrolled, and their clinical characteristics were recorded. The patients were divided into two groups based on the presence of IM. Their clinical characteristics, including demographics, clinical features, and laboratory and imaging studies, were retrospectively analyzed. Results: IM occurred in 22 of 200 (11%) neuroblastoma patients, with a median age of 42.5 months (range, 3-91 months), with a male-to-female ratio of 1.4:1. Seven patients had IM at the initial diagnosis. Among the 15 children who did not have IM at initial presentation, the median interval from presentation to the diagnosis of IM was 17.3 months (range, 1-55 months). Compared with the control group, NB patients with IM tended to be asymptomatic at the time of NB diagnosis, which was made incidentally during routine physical examination (5 of 22, 22.7%, p < 0.05). In addition, this group had more primary intra-abdominal sites (18 of 22, 81.8%, p < 0.001) and worse prognosis (5 of 22, 22.7%, p < 0.05). Conclusions: NB patients with IM have insidious onset in the early stage and a lower survival rate, especially patients with primary intra-abdominal lesions. Regular neurological monitoring could improve the rate of early diagnosis and prognosis of NB children with IM. Familiarity with the characteristic findings of NB with IM is necessary to avoid misdiagnosis and initiate necessary interventions.

Neuroblastoma with intracerebral metastases and the need for neurosurgery: a single-center experience

OBJECTIVE

Intracerebral metastases in neuroblastoma patients are rare, and information about the indication for and the outcome of neurosurgical procedures in this setting is scarce in the literature. The authors' aim in the present study was to report a single-center experience with the neurosurgical treatment of intracerebral metastases in neuroblastoma.

METHODS

This study is a retrospective single-center analysis of all neurosurgical strategies used in the treatment of intracerebral metastases in neuroblastoma patients.

RESULTS

Between 2009 and 2017, 237 pediatric patients (94 girls, 143 boys) with a mean age of 39 months at diagnosis were treated for neuroblastoma. Five (2.1%) of the 237 patients had a neurosurgical procedure for intracerebral metastases. The metastases occurred a mean of 46 months after initial diagnosis. All of these patients had neuroblastoma stage 4. Indications for surgery were recurrent metastases after initial successful oncological treatment or progression of the metastasis under oncological treatment as well as deterioration of neurological function. Intraoperatively, the tumor usually had a distinguishable dissection plane but was infiltrative to adjacent nerves in some spots. Mean overall survival after the neurosurgical procedure was 22 months. Furthermore, in another 3 patients, a neurosurgical procedure was done for an intracranial but extracerebral metastasis.

CONCLUSIONS

Neurosurgical procedures for intracerebral metastases in neuroblastoma patients are rare and were performed in 2.1% of patients in the present study. Intracerebral metastases occurred during disease progression, and the prognosis after surgery was very limited. The main indications for surgery were rapid neurological deterioration or recurrence of the metastasis after initial successful oncological treatment. Intraoperatively, the metastases usually had a distinguishable dissection plane from the normal brain tissue.