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Chen Z, Chen Y, Su Y, Jiang N, Wanggou S, Li X. Machine learning decision support model construction for craniotomy approach of pineal region tumors based on MRI images. BMC Med Imaging 2025; 25:194. [PMID: 40426149 PMCID: PMC12117726 DOI: 10.1186/s12880-025-01712-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2025] [Accepted: 05/06/2025] [Indexed: 05/29/2025] Open
Abstract
BACKGROUND Pineal region tumors (PRTs) are rare but deep-seated brain tumors, and complete surgical resection is crucial for effective tumor treatment. The choice of surgical approach is often challenging due to the low incidence and deep location. This study aims to combine machine learning and deep learning algorithms with pre-operative MRI images to build a model for PRTs surgical approaches recommendation, striving to model clinical experience for practical reference and education. METHODS This study was a retrospective study which enrolled a total of 173 patients diagnosed with PRTs radiologically from our hospital. Three traditional surgical approaches of were recorded for prediction label. Clinical and VASARI related radiological information were selected for machine learning prediction model construction. And MRI images from axial, sagittal and coronal views of orientation were also used for deep learning craniotomy approach prediction model establishment and evaluation. RESULTS 5 machine learning methods were applied to construct the predictive classifiers with the clinical and VASARI features and all methods could achieve area under the ROC (Receiver operating characteristic) curve (AUC) values over than 0.7. And also, 3 deep learning algorithms (ResNet-50, EfficientNetV2-m and ViT) were applied based on MRI images from different orientations. EfficientNetV2-m achieved the highest AUC value of 0.89, demonstrating a significant high performance of prediction. And class activation mapping was used to reveal that the tumor itself and its surrounding relations are crucial areas for model decision-making. CONCLUSION In our study, we used machine learning and deep learning to construct surgical approach recommendation models. Deep learning could achieve high performance of prediction and provide efficient and personalized decision support tools for PRTs surgical approach. CLINICAL TRIAL NUMBER Not applicable.
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Affiliation(s)
- Ziyan Chen
- Department of Neurosurgery, Xiangya Hospital, Central South University, No.87 Xiangya Road, Changsha, Hunan, P. R. China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, P. R. China
- Xiangya Hospital, Hunan International Scientific and Technological Cooperation Base of Brain Tumor Research, Central South University, Changsha, Hunan, P. R. China
| | - Yinhua Chen
- Department of Neurosurgery, Xiangya Hospital, Central South University, No.87 Xiangya Road, Changsha, Hunan, P. R. China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, P. R. China
- Xiangya Hospital, Hunan International Scientific and Technological Cooperation Base of Brain Tumor Research, Central South University, Changsha, Hunan, P. R. China
| | - Yandong Su
- Department of Neurosurgery, Changhai Hospital, Naval Medical University, Shanghai, P. R. China
| | - Nian Jiang
- Department of Neurosurgery, Xiangya Hospital, Central South University, No.87 Xiangya Road, Changsha, Hunan, P. R. China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, P. R. China
- Xiangya Hospital, Hunan International Scientific and Technological Cooperation Base of Brain Tumor Research, Central South University, Changsha, Hunan, P. R. China
| | - Siyi Wanggou
- Department of Neurosurgery, Xiangya Hospital, Central South University, No.87 Xiangya Road, Changsha, Hunan, P. R. China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, P. R. China
- Xiangya Hospital, Hunan International Scientific and Technological Cooperation Base of Brain Tumor Research, Central South University, Changsha, Hunan, P. R. China
| | - Xuejun Li
- Department of Neurosurgery, Xiangya Hospital, Central South University, No.87 Xiangya Road, Changsha, Hunan, P. R. China.
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, P. R. China.
- Xiangya Hospital, Hunan International Scientific and Technological Cooperation Base of Brain Tumor Research, Central South University, Changsha, Hunan, P. R. China.
- Xiangya School of Medicine, Central South University, Changsha, Hunan, P. R. China.
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Wu H, Maimaiti A, Huang J, Xue J, Fu Q, Wang Z, Muertizha M, Li Y, Li D, Zhou Q, Wang Y. The establishment of machine learning prognostic prediction models for pineal region tumors based on SEER-A multicenter real-world study. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2025; 51:110058. [PMID: 40300382 DOI: 10.1016/j.ejso.2025.110058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2024] [Revised: 04/02/2025] [Accepted: 04/13/2025] [Indexed: 05/01/2025]
Abstract
BACKGROUND Pineal region tumors (PRT) are rare intracranial neoplasms with diverse pathological types and growth characteristics, leading to varied clinical manifestations. This study aims to develop machine learning (ML) models for survival prediction, offering valuable insights for medical practice in the management of PRTs. METHODS Clinical information on PRTs was extracted from the Surveillance, Epidemiology, and End Results (SEER) database. The Kaplan-Meier (K-M) analysis was used to analyze the survival of PRT patients. Univariate and multivariate Cox regression analyses were conducted to identify risk factors for the survival of PRT patients. Then, nomograms were constructed. Seven ML models including Decision Tree, Logistic Regression, LightGBM, Random Forest, XGBoost, K-Nearest Neighbor Algorithm (KNN), and Support Vector Machine (SVM), were developed to predict the prognosis of PRT patients. The predictive value of ML models was evaluated by the area under the receiver's operating characteristic curve (AUC-ROC), tenfold cross verification, calibration curve, and decision curve analysis (DCA). RESULTS Univariate and multivariate Cox regression revealed that age, histopathology, radiotherapy, and tumor size were independent risk factors for overall survival (OS). Histopathology, surgery, radiotherapy, and tumor size were risk factors for cancer-specific survival (CSS). K-M survival analysis revealed that age, histopathology, marital status, radiotherapy, sex, and surgery significantly impacted OS, while age, histopathology, marital status, race, radiotherapy, sex, and surgery significantly influenced CSS. In the prediction of OS, the ML models with the best clinical utility were RF, Logistic Regression, and XGBoost. For CSS, the most effective models were RF, LightGBM, and RF. CONCLUSION ML models demonstrate significant potential and high predictive efficacy in forecasting long-term postoperative survival in PRT patients, providing substantial clinical value.
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Affiliation(s)
- Hao Wu
- Department of Neurosurgery, Neurosurgery Centre, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, 830054, China; Key Laboratory of Precision Diagnosis and Clinical Translation for Neurological Tumors of Xinjiang Medical University, Urumqi, Xinjiang, 830054, China
| | - Aierpati Maimaiti
- Department of Neurosurgery, Neurosurgery Centre, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, 830054, China; Key Laboratory of Precision Diagnosis and Clinical Translation for Neurological Tumors of Xinjiang Medical University, Urumqi, Xinjiang, 830054, China
| | - Jinlong Huang
- Department of Neurosurgery, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China
| | - Jing Xue
- Department of Pathology, The First Afffliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, 830054, China
| | - Qiang Fu
- Department of Neurosurgery, Neurosurgery Centre, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, 830054, China; Key Laboratory of Precision Diagnosis and Clinical Translation for Neurological Tumors of Xinjiang Medical University, Urumqi, Xinjiang, 830054, China
| | - Zening Wang
- Department of Neurosurgery, Neurosurgery Centre, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, 830054, China; Key Laboratory of Precision Diagnosis and Clinical Translation for Neurological Tumors of Xinjiang Medical University, Urumqi, Xinjiang, 830054, China
| | - Mamutijiang Muertizha
- Department of Neurosurgery, Neurosurgery Centre, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, 830054, China; Key Laboratory of Precision Diagnosis and Clinical Translation for Neurological Tumors of Xinjiang Medical University, Urumqi, Xinjiang, 830054, China
| | - Yang Li
- Department of Neurosurgery, Neurosurgery Centre, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, 830054, China; Key Laboratory of Precision Diagnosis and Clinical Translation for Neurological Tumors of Xinjiang Medical University, Urumqi, Xinjiang, 830054, China
| | - Di Li
- Department of Neurosurgery, Neurosurgery Centre, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, 830054, China; Key Laboratory of Precision Diagnosis and Clinical Translation for Neurological Tumors of Xinjiang Medical University, Urumqi, Xinjiang, 830054, China
| | - Qingjiu Zhou
- Department of Neurosurgery, Neurosurgery Centre, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, 830054, China; Key Laboratory of Precision Diagnosis and Clinical Translation for Neurological Tumors of Xinjiang Medical University, Urumqi, Xinjiang, 830054, China
| | - Yongxin Wang
- Department of Neurosurgery, Neurosurgery Centre, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, 830054, China; Key Laboratory of Precision Diagnosis and Clinical Translation for Neurological Tumors of Xinjiang Medical University, Urumqi, Xinjiang, 830054, China.
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Ji X, Zhang K, Wang T, Fan Y, Yuan K, Yang S, Sun X. Microsurgical Management of Pineal Region Tumors. World Neurosurg 2024; 190:e165-e174. [PMID: 39032641 DOI: 10.1016/j.wneu.2024.07.082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2024] [Accepted: 07/09/2024] [Indexed: 07/23/2024]
Abstract
BACKGROUND Pineal tumors are rare, and the pineal region is a challenging surgical location for neurosurgeons. The present study aimed to investigate the effects of microsurgical management in patients with pineal region tumors and explore probable factors associated with preoperative hydrocephalus, postoperative hydrocephalus remission, and prolonged hospital length of stay (LoS). METHODS A retrospective study of patients with pineal region tumors who underwent microsurgical management at the First Affiliated Hospital of Soochow University (Jiangsu, China) between 1 January 2010 and 31 October 2022 was conducted. RESULTS Data from 36 patients were included in this study. The top 5 common symptoms included headache (58%), dizziness (44%), double vision (22%), vomiting (19%), and nausea (14%). Patients with a lower Karnofsky Performance Score (KPS), younger age, and larger maximum tumor diameters were more vulnerable to preoperative hydrocephalus. Preoperative hydrocephalus also led to a prolonged postoperative LoS (P = 0.021). Patients with a lower KPS score (P = 0.020) or larger maximum tumor diameters (P = 0.045) were more likely to achieve postoperative remission of hydrocephalus. Most postoperative complications led to increased hospital LoS. CONCLUSIONS Microsurgical resection of pineal tumors yielded favorable long-term outcomes. Patients with a lower KPS score, younger age, and larger maximum tumor diameters were more vulnerable to preoperative hydrocephalus and prolonged LoS. Patients with a lower KPS score or larger tumor diameter were likely to achieve significant remission of hydrocephalus after tumor resection.
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Affiliation(s)
- Xiaoyu Ji
- Department of Neurosurgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Kai Zhang
- Department of Neurosurgery, Shaanxi Provincial People's Hospital, Xi'an, China
| | - Tong Wang
- Department of Neurosurgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yuhan Fan
- Department of Clinical Medicine, Suzhou Medical College of Soochow University, Suzhou, China
| | - Kun Yuan
- Department of Neurosurgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Siyuan Yang
- Department of Neurosurgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Xuebo Sun
- Department of Neurosurgery, The First Affiliated Hospital of Soochow University, Suzhou, China.
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Turcotte EL, Patra DP, Halpin BS, Bendok BR. Microsurgical Treatment of Pineal Tumors: Anatomy and Techniques. World Neurosurg 2024; 184:86. [PMID: 38211811 DOI: 10.1016/j.wneu.2024.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 01/02/2024] [Accepted: 01/03/2024] [Indexed: 01/13/2024]
Abstract
Pineal region tumors are challenging lesions in terms of surgical accessibility and removal.1 The complexity is compounded by the infrequency and heterogeneity of pineal neoplasms.2,3 In Video 1, we present the case of a 39-year-old woman who presented with progressive headaches and vision impairment. She underwent microsurgical resection for a pineal parenchymal tumor of intermediate differentiation. We discuss the rationale, risks, and benefits of treatment for this patient, as well as provide a detailed overview of the alternative approaches that may be considered. Additionally, we discuss the unique anatomic considerations for each approach and include a virtual reality-compatible 3-dimensional fly-through to highlight the relationship between the tumor and relevant venous anatomy. The patient tolerated the procedure well with excellent neurologic outcome, and her follow-up imaging showed no evidence of tumor recurrence.
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Affiliation(s)
- Evelyn L Turcotte
- Mayo Clinic Alix School of Medicine, Mayo Clinic, Phoenix, Arizona, USA; Precision Neuro-therapeutics Innovation Lab, Mayo Clinic, Phoenix, Arizona, USA; Neurosurgery Simulation and Innovation Lab, Mayo Clinic, Phoenix, Arizona, USA
| | - Devi P Patra
- Department of Neurological Surgery, Mayo Clinic, Phoenix, Arizona, USA; Precision Neuro-therapeutics Innovation Lab, Mayo Clinic, Phoenix, Arizona, USA; Neurosurgery Simulation and Innovation Lab, Mayo Clinic, Phoenix, Arizona, USA
| | - Brooke S Halpin
- Department of Neurological Surgery, Mayo Clinic, Phoenix, Arizona, USA; Precision Neuro-therapeutics Innovation Lab, Mayo Clinic, Phoenix, Arizona, USA; Neurosurgery Simulation and Innovation Lab, Mayo Clinic, Phoenix, Arizona, USA
| | - Bernard R Bendok
- Department of Neurological Surgery, Mayo Clinic, Phoenix, Arizona, USA; Precision Neuro-therapeutics Innovation Lab, Mayo Clinic, Phoenix, Arizona, USA; Neurosurgery Simulation and Innovation Lab, Mayo Clinic, Phoenix, Arizona, USA; Department of Otolaryngology-Head & Neck Surgery, Mayo Clinic, Phoenix, Arizona, USA; Department of Radiology, Mayo Clinic, Phoenix, Arizona, USA.
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Bianconi A, Panico F, Lo Zito B, Do Trinh A, Cassoni P, Ricardi U, Garbossa D, Cofano F, Mantovani C, Bertero L. Understanding and Managing Pineal Parenchymal Tumors of Intermediate Differentiation: An In-Depth Exploration from Pathology to Adjuvant Therapies. J Clin Med 2024; 13:1266. [PMID: 38592098 PMCID: PMC10931940 DOI: 10.3390/jcm13051266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 02/16/2024] [Accepted: 02/21/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND Pineal parenchymal cell tumors constitute a rare group of primary central nervous system neoplasms (less than 1%). Their classification, especially the intermediate subtype (PPTIDs), remains challenging. METHODS A literature review was conducted, navigating through anatomo-pathological, radiotherapy, and neurosurgical dimensions, aiming for a holistic understanding of these tumors. RESULTS PPTIDs, occupying an intermediate spectrum of malignancy, reveal diverse histological patterns, mitotic activity, and distinct methylation profiles. Surgical treatment is the gold standard, but when limited to partial removal, radiotherapy becomes crucial. While surgical approaches are standardized, due to the low prevalence of the pathology and absence of randomized prospective studies, there are no shared guidelines about radiation treatment modalities. CONCLUSION Surgical removal remains pivotal, demanding a personalized approach based on the tumor extension. This review underscores the considerable variability in treatment approaches and reported survival rates within the existing literature, emphasizing the need for ongoing research to better define optimal therapeutic strategies and prognostic factors for PPTIDs, aiming for further and more detailed stratification among them.
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Affiliation(s)
- Andrea Bianconi
- Neurosurgery Unit, Department of Neuroscience, University of Turin, 10126 Turin, Italy
| | - Flavio Panico
- Neurosurgery Unit, Department of Neuroscience, University of Turin, 10126 Turin, Italy
| | - Bruna Lo Zito
- Radiation Oncology Unit, Department of Oncology, University of Turin, 10126 Turin, Italy
| | - Andrea Do Trinh
- Pathology Unit, Department of Medical Sciences, University of Turin, 10126 Turin, Italy
| | - Paola Cassoni
- Pathology Unit, Department of Medical Sciences, University of Turin, 10126 Turin, Italy
| | - Umberto Ricardi
- Radiation Oncology Unit, Department of Oncology, University of Turin, 10126 Turin, Italy
| | - Diego Garbossa
- Neurosurgery Unit, Department of Neuroscience, University of Turin, 10126 Turin, Italy
| | - Fabio Cofano
- Neurosurgery Unit, Department of Neuroscience, University of Turin, 10126 Turin, Italy
| | - Cristina Mantovani
- Radiation Oncology Unit, Department of Oncology, University of Turin, 10126 Turin, Italy
| | - Luca Bertero
- Pathology Unit, Department of Medical Sciences, University of Turin, 10126 Turin, Italy
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Huang LT, Zhou Q, Tong X. Treatment of Pineal Region Lesions in Children. J Craniofac Surg 2024; 35:e60-e66. [PMID: 37948620 DOI: 10.1097/scs.0000000000009846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 10/01/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Pineal region lesions are more common in children than adults; however, therapeutic strategies for pineal region lesions in children are controversial. METHODS A retrospective study involving 54 pediatric with pineal region lesions was conducted. The therapeutic strategies for lesions and hydrocephalus were classified and analyzed. RESULTS Radiotherapy of pineal region lesions was shown to result in better postoperative recovery and fewer complications in the short-term compared with lesion resection. Total resection was related to smaller lesion size, endoscopic procedures, and a better prognosis. Cerebrospinal fluid (CSF) diversion before the resection reduced hydrocephalus recurrences, whereas further lesion resection had a negative short-term influence on CSF diversion. Among the 4 therapeutic strategies to manage hydrocephalus, a third ventriculostomy (ETV) was reasonable and further resection did not have a negative impact on the ETV. The relief of hydrocephalus was also related to better postoperative recovery, a higher total resection rate, fewer complications, and a better prognosis. Logistical regression analysis indicated that lesion size and intracranial complications were predictors of outcome. CONCLUSIONS For lesion treatment, total resection and radiotherapy are essential components in children. Total resection and CSF diversion before resection were beneficial, whereas further lesion resection had a negative impact on CSF diversion. For hydrocephalus treatment, ETV was shown to be the best therapeutic strategy for management of pediatric hydrocephalus. Total resection and better preoperative health status were associated with greater hydrocephalus relief. For the overall prognosis, a lack of hydrocephalus relief was associated with poor outcomes. Lesion size and intracranial complications may be the best predictors of outcome.
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Affiliation(s)
- Li-Tian Huang
- Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin
| | - Quan Zhou
- Department of Neurosurgery, The First Affiliated Hospital of Guangxi Medical University, No 6 Shuang Yong Road Nanning, Guangxi, Guangxi Province, China
| | - Xiaoguang Tong
- Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin
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Huang LT, Wang CX, Li T, Wang SY, Zhou Q, Tong X. Optimal therapeutic strategies for pineal region lesions. Front Neurol 2023; 14:1261054. [PMID: 38107642 PMCID: PMC10722988 DOI: 10.3389/fneur.2023.1261054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 11/06/2023] [Indexed: 12/19/2023] Open
Abstract
Background The removal of pineal region lesions are challenging, and therapeutic strategies for their removal remain controversial. The current study was conducted to identify the characteristics and the optimal therapeutic strategies for pineal region lesions. Methods This retrospective study reviewed the treatments of 101 patients with pineal region lesions, and different characteristics and therapeutic strategies were observed. Results There were no statistical differences in the total resection ratio, complications, and prognosis outcomes between the hydrocephalus group and non-hydrocephalus group, except patients in the hydrocephalus group were younger and pediatric patients had an increased level of intracranial infections. Treatments of lesions and hydrocephalus secondary to pineal region lesions were two integral parts to therapeutic strategies. For the management of lesions, germinoma or non-germinoma were diagnosed preoperatively, and resection or diagnostic radiation were chosen to deal with pineal region lesions. Endoscopic-assisted surgery provided a higher total resection rate. For the management of hydrocephalus, endoscopic third ventriculostomy (ETV) had the better therapeutic effect. Additionally, cerebrospinal fluid (CSF) diversion before radiotherapy or resection did not improve prognosis outcome, but it was necessary for patients with severe hydrocephalus. Logistical regression analysis indicated that age, lesion size, reoperation ratio, and intracranial complications were predictors of prognosis outcome. Conclusion More attention should be paid to intracranial infections in pediatric patients with hydrocephalus secondary to pineal region lesions, and CSF diversion before radiotherapy or resection did not promote prognosis outcome, but it was necessary for patients with severe hydrocephalus. Age, lesion size, reoperation ratio, and intracranial complications may be the predictors of prognosis outcome. Most importantly, the surgical algorithm for pineal region lesions which was based on preoperatively diagnosis (non-germinoma and germinoma) is useful, especially for developing countries.
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Affiliation(s)
- Li-tian Huang
- Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin, China
| | - Chun-xi Wang
- Department of Neurosurgery, The First Affiliated Hospital of Guangxi Medical University, Guangxi, China
| | - Tang Li
- Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin, China
- Department of Neurosurgery, The First Affiliated Hospital of Guangxi Medical University, Guangxi, China
| | - Sheng-yong Wang
- Department of Neurosurgery, The First Affiliated Hospital of Guangxi Medical University, Guangxi, China
| | - Quan Zhou
- Department of Neurosurgery, The First Affiliated Hospital of Guangxi Medical University, Guangxi, China
| | - Xiaoguang Tong
- Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin, China
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Price M, Neff C, Kruchko C, Barnholtz-Sloan JS, Cordeiro BB, Penas-Prado M, Ozer BH, Cimino PJ, Gilbert MR, Armstrong TS, Ostrom QT. Capturing evolving definitions of 12 select rare CNS tumors: a timely report from CBTRUS and NCI-CONNECT. J Neurooncol 2023; 165:279-290. [PMID: 37980692 DOI: 10.1007/s11060-023-04480-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 10/11/2023] [Indexed: 11/21/2023]
Abstract
PURPOSE Incidence, prevalence, and survival are population-based statistics describing cancer burden. The National Cancer Institute's (NCI) Comprehensive Oncology Network Evaluating Rare CNS Tumors (NCI-CONNECT) specializes in tumor biology and outcomes for 12 rare CNS tumor types selected for their importance in adults, research interest, or potential for targeted treatment. The aim of this study was to update incidence, prevalence, and survival statistics for these tumors. METHODS The Central Brain Tumor Registry of the United States (CBTRUS) database, a combined dataset of Centers for Disease Control and Prevention's (CDC) National Program of Cancer Registries (NPCR) and NCI's Surveillance, Epidemiology and End Results (SEER) data, was used to calculate average annual age-adjusted incidence rates (AAAIR) per 100,000 population overall and by sex, race-ethnicity, and age for diagnosis years 2008-2019. Incidence time trends were calculated for diagnosis years 2004-2019. NPCR data were used to calculate relative survival rates. Point prevalence on December 31, 2019 was estimated using annual age-specific incidence and survival. RESULTS AAAIR was 1.47 per 100,000 for these tumors combined, with highest incidence in ependymomas (AAAIR = 0.41/100,000). Most tumor types were more common in males, adults (ages 40 + years) or children (ages < 15 years), and non-Hispanic White individuals. Ependymomas were the most prevalent tumor type (19,320 cases) followed by oligodendrogliomas (14,900 cases). Ependymomas had the highest five-year survival (90.6%) and primary CNS sarcomas the lowest (7.7%). CONCLUSIONS These data provide means to measure the impact of clinical care and evaluate new therapies and the evolving histopathology definitions in rare CNS tumor types.
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Affiliation(s)
- Mackenzie Price
- Central Brain Tumor Registry of the United States (CBTRUS), Hinsdale, IL, USA
- Department of Neurosurgery, Duke University School of Medicine, Durham, NC, USA
| | - Corey Neff
- Central Brain Tumor Registry of the United States (CBTRUS), Hinsdale, IL, USA
- Department of Neurosurgery, Duke University School of Medicine, Durham, NC, USA
| | - Carol Kruchko
- Central Brain Tumor Registry of the United States (CBTRUS), Hinsdale, IL, USA
| | - Jill S Barnholtz-Sloan
- Central Brain Tumor Registry of the United States (CBTRUS), Hinsdale, IL, USA
- Trans Divisional Research Program (TDRP), Division of Cancer Epidemiology and Genetics (DCEG), National Cancer Institute (NCI), Bethesda, MD, USA
- Center for Biomedical Informatics & Information Technology (CBIIT), National Cancer Institute (NCI), Bethesda, MD, USA
| | - Brittany B Cordeiro
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute (NCI), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Marta Penas-Prado
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute (NCI), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Byram H Ozer
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute (NCI), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Patrick J Cimino
- NIH National Institute of Neurological Disorders and Stroke, Surgical Neurology Branch, Neuropathology Unit, Bethesda, MD, USA
| | - Mark R Gilbert
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute (NCI), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Terri S Armstrong
- Neuro-Oncology Branch, Center for Cancer Research, National Cancer Institute (NCI), National Institutes of Health (NIH), Bethesda, MD, USA.
| | - Quinn T Ostrom
- Central Brain Tumor Registry of the United States (CBTRUS), Hinsdale, IL, USA.
- Department of Neurosurgery, Duke University School of Medicine, Durham, NC, USA.
- Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA.
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Bal J, Fairhead RJ, Matloob S, Shapey J, Romani R, Gavin C, Shoakazemi A, Pollock J. The Use of the Suboccipital Transtentorial Approach to the Posterior Inferior Incisural Space. Cureus 2023; 15:e47705. [PMID: 38021782 PMCID: PMC10674890 DOI: 10.7759/cureus.47705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2023] [Indexed: 12/01/2023] Open
Abstract
Objective To describe our experience with the microsurgical technique of the suboccipital transtentorial (SOTT) approach in the removal of posterior fossa lesions located in the posterior incisural space. Method Between 2002 and 2020 we reviewed all patients who underwent microsurgical resection of lesions of the posterior incisural space at the Department of Neurosurgery, Essex Neuroscience Centre, London, England (eight patients, male to female 3:5, mean age: 51, range 35-69). We describe the preoperative symptoms, radiological findings, surgical techniques, histology and postoperative outcomes in this cohort of patients. Results Eight patients with tumours located in the posterior incisural space underwent surgery during the study period including four meningiomas (50%), two haemangioblastomas (25%), one metastasis (13%) and one giant prolactinoma (13%). Gross or near total resection was achieved in six patients (75%): the giant prolactinoma could not be radically removed and one of the meningiomas required a small fragment to be left in place to protect the Vein of Galen. No patient developed a visual field deficit due to occipital lobe retraction. One patient developed a temporary trochlear nerve palsy (13%). Five patients had mild disability (Glasgow Outcome Scale (GOS) = 5), and four had moderate disability (GOS = 4). Conclusion In our series, the SOTT approach provided excellent access for all cases of tumours in the posterior incisural space. The tumour's size and relationship to the deep venous system contributed to the choice of approach and in one patient who had previously undergone surgery via the supracerebellar route, the SOTT approach enabled the avoidance of gliotic scar tissue. Success is dependent on careful case selection, though from our series of 8 patients, we conclude that this approach allows safe access to the posterior incisural space, with acceptable outcomes with regard to postoperative disability and cranial nerve palsy. As such, the approach should be in the armamentarium of any neurosurgeon who regularly deals with posterior fossa pathology.
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Affiliation(s)
- Jarnail Bal
- Neurosurgery, Royal London Hospital, London, GBR
| | | | | | | | - Rossana Romani
- Neurosurgery, Southampton General Hospital National Health Service (NHS) Foundation Trust, London, GBR
| | - Cormac Gavin
- Neurosurgery, The Royal Hallamshire Hospital, Sheffield, GBR
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Malik N, Samples DC, Finneran MM, Graber S, Dorris K, Norris G, Foreman NK, Hankinson TC, Handler MH. Pediatric pineal region masses: a single-center experience over 25 years. Childs Nerv Syst 2023; 39:2307-2316. [PMID: 35831712 DOI: 10.1007/s00381-022-05593-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 06/23/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE Pineal region tumors (PRT) represent less than 1% of brain neoplasms. The rare and heterogeneous nature of these tumors is reflected in the variety of treatment modalities employed. METHODS A single-center retrospective review of all pediatric patients with pineal region tumors between November 1996 and June 2021 was performed. Fifty-six cases of pineal tumors were reviewed for age and symptoms upon presentation, diagnostic methods, imaging characteristics, histological classification, treatment modalities, recurrence, and mortality rates. RESULTS The average age at diagnosis was 11.3 years. The majority of patients were male (82.1%) and Caucasian (73.2%). The most common presenting symptoms were headache (n = 38, 67.9%) and visual problems (n = 34, 60.7%). Hydrocephalus was present in 49 patients (87.5%). Germinoma (n = 20, 35.7%) and non-germinomatous germ cell tumor (NGGCT) (n = 17, 30.4%) were the most common tumors. Chemotherapy was employed for 54 patients (96.4%), radiation for 49 (87.5%), and surgical resection for 14 (25.0%). The average duration of treatment was 5.9 months. Progression-free survival was 74.4% at 5 years and 72.0% at 10 years. Overall survival was 85.7% at 5 years and 77.1% at 10 years. CONCLUSION Treatment of pineal region tumors must be targeted to each patient based on presentation, subtype, presence of hydrocephalus, and extent of disease. Upfront surgical resection is usually not indicated. As advances in oncological care proceed, treatment modalities may continue to improve in efficacy.
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Affiliation(s)
- Noor Malik
- Department of Pediatric Neurosurgery, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA
| | - Derek C Samples
- Department of Pediatric Neurosurgery, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA
| | - Megan M Finneran
- Department of Pediatric Neurosurgery, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA
- Department of Neurological Surgery, Carle BroMenn Medical Center, Normal, IL, USA
| | - Sarah Graber
- Department of Pediatric Neurosurgery, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA
| | - Kathleen Dorris
- Department of Pediatrics, Center for Cancer and Blood Disorders, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA
| | - Gregory Norris
- Department of Pediatrics, Center for Cancer and Blood Disorders, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA
| | - Nicholas K Foreman
- Department of Pediatrics, Center for Cancer and Blood Disorders, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA
| | - Todd C Hankinson
- Department of Pediatric Neurosurgery, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA
| | - Michael H Handler
- Department of Pediatric Neurosurgery, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA.
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Mehkri Y, Gendreau JL, Fox K, Hameed NUF, Jimenez MA, Mukherjee D. Radiotherapy Is Associated With Improved Overall Survival in Adult Pineoblastoma: A SEER Database Analysis. World Neurosurg 2023; 172:e312-e318. [PMID: 36627016 DOI: 10.1016/j.wneu.2023.01.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 01/04/2023] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Pineoblastomas (PBLs) are rare high-grade tumors treated variably with surgery and/or radiation. The role of surgical extent of resection and radiotherapy (RT) in adult PBL remains unclear. We queried the Surveillance, Epidemiology, and End Results (SEER) database to assess these variables' effects on overall survival (OS) in adult PBL. METHODS The SEER (1975-2016) database was queried for adult patients with diagnosis of PBL (ICD-0-3: 9362/3). Variables extracted included age, sex, race, geographical region, extent of tumor resection, RT, chemotherapy (CT), and OS data. Comparisons were performed with the χ2 test for categorical variables, Cox proportional hazards models to assess the association of clinical variables on OS, and Kaplan-Meier curves were generated. RESULTS A total of 201 patients with PBL were identified with mean age 40.0 years (interquartile range 27.0-51.0) and most patients being male (53%) and Caucasian (77%). 101 (50%) patients received RT, and gross total resection was achieved in 83 (41%). Age stratification by decade revealed statistically significant poorer OS in patients aged ≥70 years. In bivariate analysis, RT with or without surgery was associated with improved 5-year OS compared with no RT (77.3% vs. 63.2%, P = 0.020). In multivariate analysis, age was a poor prognostic factor for OS (P < 0.001) and RT did appear to improve survival (P = 0.020). Extent of surgical resection was not significantly associated with improved survival. CONCLUSIONS In adult patients with PBL, RT may offer an OS benefit irrespective of surgery or extent of surgical resection. Patients ≥70 years of age are associated with poorer OS.
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Affiliation(s)
- Yusuf Mehkri
- Department of Neurosurgery, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Julian L Gendreau
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Keiko Fox
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - N U Farrukh Hameed
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Miguel A Jimenez
- Department of Neurological Surgery, The University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA
| | - Debraj Mukherjee
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
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12
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Diagnosis and Treatment of Pineal Region Tumors in Adults: A EURACAN Overview. Cancers (Basel) 2022; 14:cancers14153646. [PMID: 35954310 PMCID: PMC9367474 DOI: 10.3390/cancers14153646] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 07/22/2022] [Accepted: 07/25/2022] [Indexed: 02/01/2023] Open
Abstract
Simple Summary Pineal region tumors are rare intracranial tumors. A deeper knowledge of these tumors’ molecular mechanisms has been gained in recent years, which has led to a new classification and new potential systemic treatments. Surgery remains the mainstay of treatment, while radiotherapy and systemic therapy depend on histological, molecular, and clinical characteristics. This paper highlights recent developments in the diagnosis and treatment of these tumors. Abstract Pineal region tumors are rare intracranial tumors, accounting for less than 1% of all adult intracranial tumor lesions. These lesions represent a histologically heterogeneous group of tumors. Among these tumors, pineal parenchymal tumors and germ cell tumors (GCT) represent the most frequent types of lesions. According to the new WHO 2021 classification, pineal parenchymal tumors include five distinct histotypes: pineocytoma (PC), pineal parenchymal tumors of intermediate differentiation (PPTID), papillary tumor of the pineal region (PTPR), pinealoblastoma (PB), and desmoplastic myxoid tumor of the pineal region, SMARCB1-mutant; GCTs include germinoma, embryonal carcinoma, yolk sac tumor, choriocarcinoma, teratoma, mixed GCTs. Neuroradiological assessment has a pivotal role in the diagnostic work-up, surgical planning, and follow-up of patients with pineal masses. Surgery can represent the mainstay of treatment, ranging from biopsy to gross total resection, yet pineal region tumors associated with obstructive hydrocephalus may be surgically managed via ventricular internal shunt or endoscopic third ventriculostomy. Radiotherapy remains an essential component of the multidisciplinary treatment approach for most pineal region tumors; however, treatment volumes depend on the histological subtypes, grading, extent of disease, and the combination with chemotherapy. For localized germinoma, the current standard of care is chemotherapy followed by reduced-dose whole ventricular irradiation plus a boost to the primary tumor. For pinealoblastoma patients, postoperative radiation has been associated with higher overall survival. For the other pineal tumors, the role of radiotherapy remains poorly studied and it is usually reserved for aggressive (grade 3) or recurrent tumors. The use of systemic treatments mainly depends on histology and prognostic factors such as residual disease and metastases. For pinealoblastoma patients, chemotherapy protocols are based on various alkylating or platinum-based agents, vincristine, etoposide, cyclophosphamide and are used in association with radiotherapy. About GCTs, their chemosensitivity is well known and is based on cisplatin or carboplatin and may include etoposide, cyclophosphamide, or ifosfamide prior to irradiation. Similar regimens containing platinum derivatives are also used for non-germinomatous GCTs with very encouraging results. However, due to a greater understanding of the biology of the disease’s various molecular subtypes, new agents based on targeted therapy are expected in the future. On behalf of the EURACAN domain 10 group, we reviewed the most important and recent developments in histopathological characteristics, neuro-radiological assessments, and treatments for pineal region tumors.
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Shabo E, Czech T, Nicholson JC, Mallucci C, Mottolese C, Piatelli G, Frappaz D, Murray MJ, Faure-Conter C, Garrè ML, Sarikaya-Seiwert S, Weinhold L, Haberl H, Calaminus G. Evaluation of the Perioperative and Postoperative Course of Surgery for Pineal Germinoma in the SIOP CNS GCT 96 Trial. Cancers (Basel) 2022; 14:cancers14143555. [PMID: 35884617 PMCID: PMC9323477 DOI: 10.3390/cancers14143555] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 07/16/2022] [Accepted: 07/18/2022] [Indexed: 02/05/2023] Open
Abstract
Background: CNS germinoma, being marker-negative, are mainly diagnosed by histological examination. These tumors predominantly appear in the suprasellar and/or pineal region. In contrast to the suprasellar region, where biopsy is the standard procedure in case of a suspected germ-cell tumor to avoid mutilation to the endocrine structures, pineal tumors are more accessible to primary resection. We evaluated the perioperative course of patients with pineal germinoma who were diagnosed by primary biopsy or resection in the SIOP CNS GCT 96 trial. Methods: Overall, 235 patients had germinoma, with pineal localization in 113. The relationship between initial symptoms, tumor size, and postoperative complications was analyzed. Results: Of 111 evaluable patients, initial symptoms were headache (n = 98), hydrocephalus (n = 93), double vision (n = 62), Parinaud syndrome (n = 57), and papilledema (n = 44). There was no significant relationship between tumor size and primary symptoms. A total of 57 patients underwent primary resection and 54 underwent biopsy. Postoperative complications were reported in 43.2% of patients after resection and in 11.4% after biopsy (p < 0.008). Biopsy was significantly more commonly performed on larger tumors (p= 0.002). Conclusions: These results support the practice of biopsy over resection for histological confirmation of pineal germinoma.
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Affiliation(s)
- Ehab Shabo
- Department of Neurosurgery, Rheinische Friedrich-Wilhelms-University, Sigmund-Freud-Straße 25, 53127 Bonn, Germany
- Correspondence: ; Tel.: +49-228-287-16521; Fax: +49-228-287-11366
| | - Thomas Czech
- Department of Neurosurgery, Medical University of Vienna, 1090 Vienna, Austria;
| | - James C. Nicholson
- Department of Paediatric Haematology and Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK;
| | - Conor Mallucci
- Department of Neurosurgery, Alder Hey Children’s Hospital, Liverpool L14 5AB, UK; (C.M.); (M.J.M.)
| | - Carmine Mottolese
- Neurochirurgie Pédiatrique, Hôpital Femme-Mère-Enfant, Université de Lyon, 59, Boulevard Pinel, 69003 Lyon, France;
| | - Gianluca Piatelli
- Division of Neurosurgery, Department of Neurosciences, Giannina Gaslini Children’s Hospital, 16147 Genvoa, Italy;
| | - Didier Frappaz
- Department of Pediatric Hematology and Oncology, Institut d’Hématologie et d’Oncologie Pédiatrique, 69008 Lyon, France; (D.F.); (C.F.-C.)
| | - Matthew Jonathan Murray
- Department of Neurosurgery, Alder Hey Children’s Hospital, Liverpool L14 5AB, UK; (C.M.); (M.J.M.)
- Department of Pathology, University of Cambridge, Tennis Court Road, Cambridge CB2 1QP, UK
| | - Cecile Faure-Conter
- Department of Pediatric Hematology and Oncology, Institut d’Hématologie et d’Oncologie Pédiatrique, 69008 Lyon, France; (D.F.); (C.F.-C.)
| | - Maria Luisa Garrè
- Department of Pediatric Hematology-Oncology and Bone Marrow Transplantation, IRCCS Istituto Giannina Gaslini, 16147 Genova, Italy;
| | - Sevgi Sarikaya-Seiwert
- Section of Pediatric Neurosurgery, Department of Neurosurgery, Rheinische, Friedrich-Wilhelms-University, Sigmund-Freud-Straße 25, 53127 Bonn, Germany; (S.S.-S.); (H.H.)
| | - Leonie Weinhold
- Department of Medical Biometry, Informatics and Epidemiology, University Hospital Bonn, 53127 Bonn, Germany;
| | - Hannes Haberl
- Section of Pediatric Neurosurgery, Department of Neurosurgery, Rheinische, Friedrich-Wilhelms-University, Sigmund-Freud-Straße 25, 53127 Bonn, Germany; (S.S.-S.); (H.H.)
| | - Gabriele Calaminus
- Department of Pediatric Hematology and Oncology, University Hospital Bonn, Venusberg-Campus 1, 53127 Bonn, Germany;
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