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Schaumann A, Hammar C, Alsleben S, Schulz M, Grün A, Lankes E, Tietze A, Koch A, Hernáiz Driever P, Thomale UW. Neurosurgical treatment of pediatric brain tumors - results from a single center multidisciplinary setup. Childs Nerv Syst 2024; 40:381-393. [PMID: 37730915 PMCID: PMC10837233 DOI: 10.1007/s00381-023-06123-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 08/09/2023] [Indexed: 09/22/2023]
Abstract
OBJECTIVE The challenge of pediatric brain tumor surgery is given due to a relative low prevalence but high heterogeneity in age, localization, and pathology. Improvements of long-term overall survival rates were achieved during the past decades stressing the importance of a multidisciplinary decision process guided by a national treatment protocol. We reviewed the entire spectrum of pediatric brain tumor surgeries from the perspective of an interdisciplinary pediatric neuro-oncology center in Germany. METHODS Every patient who underwent brain tumor surgery from January 2010 to June 2017 in our Pediatric Neurosurgery department was retrospectively included and evaluated regarding the course of treatment. Perioperative data such as tumor localization, timing of surgery, extent of resection, neuropathological diagnosis, transfusion rates, oncologic and radiation therapy, and neurological follow-up including morbidity and mortality were evaluated. RESULTS Two hundred ninety-three pediatric brain tumor patients were applicable (age: 8.28 ± 5.62 years, 1.22:1.0 m:f). A total of 531 tumor surgical interventions was performed within these patients (457 tumor resections, 74 tumor biopsies; mean interventions per patient 1.8 ± 1.2). Due to a critical neurologic status, 32 operations (6%) were performed on the day of admission. In 65.2% of all cases, tumor were approached supratentorially. Most frequent diagnoses of the cases were glial tumors (47.8%) and embryonal tumors (17.6%). Preoperative planned extent of resection was achieved in 92.7%. Pre- and postoperative neurologic deficits resolved completely in 30.7%, whereas symptom regressed in 28.6% of surgical interventions. New postoperative neurologic deficit was observed in 10.7%, which resolved or improved in 80% of these cases during 30 days. The mortality rate was 1%. CONCLUSION We outlined the center perspective of a specialized pediatric neuro-oncological center describing the heterogeneous distribution of cases regarding age-related prevalence, tumor localization, and biology, which requires a high multidisciplinary expertise. The study contributes to define challenges in treating pediatric brain tumors and to develop quality indicators for pediatric neuro-oncological surgery. We assume that an adequate volume load of patients within a interdisciplinary infrastructure is warranted to aim for effective treatment and decent quality of life for the majority of long-term surviving pediatric tumor patients.
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Affiliation(s)
- A Schaumann
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Pediatric Neurosurgery, Augustenburger Platz 1, 13353, Berlin, Germany
| | - C Hammar
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Pediatric Neurosurgery, Augustenburger Platz 1, 13353, Berlin, Germany
| | - S Alsleben
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Pediatric Neurosurgery, Augustenburger Platz 1, 13353, Berlin, Germany
| | - M Schulz
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Pediatric Neurosurgery, Augustenburger Platz 1, 13353, Berlin, Germany
| | - A Grün
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department for Radiation Oncology and Radiotherapy, Augustenburger Platz 1, 13353, Berlin, Germany
| | - E Lankes
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Pediatric Endocrinology and Diabetes, Augustenburger Platz 1, 13353, Berlin, Germany
| | - A Tietze
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Neuroradiology, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Arend Koch
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Neuropathology, Berlin, Germany
| | - P Hernáiz Driever
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Pediatric Hematology and Oncology, Augustenburger Platz 1, 13353, Berlin, Germany
| | - U-W Thomale
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Pediatric Neurosurgery, Augustenburger Platz 1, 13353, Berlin, Germany.
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Taghiakbari M, Hammar C, Frenn M, Djinbachian R, Pohl H, Deslandres E, Bouchard S, Bouin M, von Renteln D. Non-optical polyp-based resect and discard strategy: A prospective clinical study. World J Gastroenterol 2022; 28:2137-2147. [PMID: 35664039 PMCID: PMC9134134 DOI: 10.3748/wjg.v28.i19.2137] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Revised: 03/21/2022] [Accepted: 04/09/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Post-polypectomy surveillance intervals are currently determined based on pathology results. AIM To evaluate a polyp-based resect and discard model that assigns surveillance intervals based solely on polyp number and size. METHODS Patients undergoing elective colonoscopies at the Montreal University Medical Center were enrolled prospectively. The polyp-based strategy was used to assign the next surveillance interval using polyp size and number. Surveillance intervals were also assigned using optical diagnosis for small polyps (< 10 mm). The primary outcome was surveillance interval agreement between the polyp-based model, optical diagnosis, and the pathology-based reference standard using the 2020 United States Multi-Society Task Force guidelines. Secondary outcomes included the proportion of reduction in required histopathology evaluations and proportion of immediate post-colonoscopy recommendations provided to patients. RESULTS Of 944 patients (mean age 62.6 years, 49.3% male, 933 polyps) were enrolled. The surveillance interval agreement for the polyp-based strategy was 98.0% [95% confidence interval (CI): 0.97-0.99] compared with pathology-based assignment. Optical diagnosis-based intervals achieved 95.8% (95%CI: 0.94-0.97) agreement with pathology. When using the polyp-based strategy and optical diagnosis, the need for pathology assessment was reduced by 87.8% and 70.6%, respectively. The polyp-based strategy provided 93.7% of patients with immediate surveillance interval recommendations vs 76.1% for optical diagnosis. CONCLUSION The polyp-based strategy achieved almost perfect surveillance interval agreement compared with pathology-based assignments, significantly reduced the number of required pathology evaluations, and provided most patients with immediate surveillance interval recommendations.
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Affiliation(s)
- Mahsa Taghiakbari
- Department of Gastroenterology, Montreal University Hospital Research Center (CRCHUM), Montréal H2X 0A9, Quebec, Canada
| | - Celia Hammar
- Department of Gastroenterology, Montreal University Hospital Research Center (CRCHUM), Montréal H2X 0A9, Quebec, Canada
- Department of Gastroenterology, University of Montreal, Faculty of Medicine, Montreal H2X 0A9, Quebce, Canada
| | - Mira Frenn
- Department of Gastroenterology, Montreal University Hospital Research Center (CRCHUM), Montréal H2X 0A9, Quebec, Canada
- Department of Gastroenterology, University of Montreal, Faculty of Medicine, Montreal H2X 0A9, Quebce, Canada
| | - Roupen Djinbachian
- Department of Gastroenterology, Montreal University Hospital Research Center (CRCHUM), Montréal H2X 0A9, Quebec, Canada
- Department of Internal Medicine, University of Montreal Hospital Center (CHUM), Montreal H2X 0A9, Quebec, Canada
| | - Heiko Pohl
- Department of Medicine, Veterans Affairs Medical Center, White River Junction, VT 05009, United States
- Department of Gastroenterology, Dartmouth Geisel School of Medicine and The Dartmouth Institute, Hanover, NH 03755, United States
| | - Erik Deslandres
- Department of Gastroenterology, Montreal University Hospital Research Center (CRCHUM), Montréal H2X 0A9, Quebec, Canada
| | - Simon Bouchard
- Department of Gastroenterology, Montreal University Hospital Research Center (CRCHUM), Montréal H2X 0A9, Quebec, Canada
| | - Mickael Bouin
- Department of Gastroenterology, Montreal University Hospital Research Center (CRCHUM), Montréal H2X 0A9, Quebec, Canada
| | - Daniel von Renteln
- Department of Gastroenterology, Montreal University Hospital Research Center (CRCHUM), Montréal H2X 0A9, Quebec, Canada
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Hammar C, Viklund J, Leppert J, Henriksen E, Hellberg A, Lönnberg I, Hedberg P. LEFT VENTRICULAR MYOCARDIAL SYSTOLIC VELOCITY, BUT NOT EJECTION FRACTION, IS REDUCED IN PATIENTS WITH PERIPHERAL ARTERY DISEASE. ATHEROSCLEROSIS SUPP 2008. [DOI: 10.1016/s1567-5688(08)70923-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Hammar C, Tegner Y. [Sacroiliitis as a complication of isoretinoid therapy]. Lakartidningen 1990; 87:2513. [PMID: 2398771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- C Hammar
- Ortopedkliniken, Centrallasarettet, Boden
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