Magnetic resonance-guided stereotactic laser ablation therapy for the treatment of pediatric brain tumors: a multiinstitutional retrospective study.

Autor:	Arocho-Quinones EV; 1Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin., Lew SM; 1Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin.; 2Department of Neurosurgery, Children's Hospital of Wisconsin, Milwaukee, Wisconsin., Handler MH; 3Department of Neurosurgery, Children's Hospital Colorado, Aurora, Colorado., Tovar-Spinoza Z; 4Department of Neurosurgery, SUNY Upstate Medical University, Syracuse, New York., Smyth M; 5Department of Neurosurgery, St. Louis Children's Hospital, St. Louis, Missouri., Bollo R; 6Department of Neurosurgery, Primary Children's Hospital, Salt Lake City, Utah., Donahue D; Departments of7Neurosurgery and., Perry MS; 8Neurology, Cook Children's Hospital, Fort Worth, Texas., Levy ML; 9Department of Neurosurgery, Rady Children's Hospital-San Diego, California., Gonda D; 9Department of Neurosurgery, Rady Children's Hospital-San Diego, California., Mangano FT; 10Department of Neurosurgery, Cincinnati Children's Hospital, Cincinnati, Ohio., Storm PB; 11Department of Neurosurgery, Children's Hospital of Philadelphia, Pennsylvania., Price AV; 12Department of Neurosurgery, University of Texas Southwestern Medical Center, Dallas, Texas., Couture DE; 13Department of Neurosurgery, Wake Forest Baptist Health, Winston-Salem, North Carolina., Oluigbo C; 14Department of Neurosurgery, Children's National Health System, Washington, DC., Duhaime AC; 15Department of Neurosurgery, Massachusetts General Hospital for Children, Boston, Massachusetts., Barnett GH; 16Department of Neurosurgery, Cleveland Clinic Children's, Cleveland, Ohio., Muh CR; 17Department of Neurosurgery, Duke Children's Hospital, Durham, North Carolina., Sather MD; 18Department of Neurosurgery, Penn State Health, Hershey, Pennsylvania., Fallah A; 19Department of Neurosurgery, UCLA Mattel Children's Hospital, Los Angeles, California., Wang AC; 19Department of Neurosurgery, UCLA Mattel Children's Hospital, Los Angeles, California., Bhatia S; 20Department of Neurosurgery, Nicklaus Children's Hospital, Miami, Florida; and., Patel K; 21Department of Biostatistics, Medical College of Wisconsin, Milwaukee, Wisconsin., Tarima S; 21Department of Biostatistics, Medical College of Wisconsin, Milwaukee, Wisconsin., Graber S; 3Department of Neurosurgery, Children's Hospital Colorado, Aurora, Colorado., Huckins S; 4Department of Neurosurgery, SUNY Upstate Medical University, Syracuse, New York., Hafez DM; 5Department of Neurosurgery, St. Louis Children's Hospital, St. Louis, Missouri., Rumalla K; 5Department of Neurosurgery, St. Louis Children's Hospital, St. Louis, Missouri., Bailey L; Departments of7Neurosurgery and., Shandley S; Departments of7Neurosurgery and., Roach A; 10Department of Neurosurgery, Cincinnati Children's Hospital, Cincinnati, Ohio., Alexander E; 11Department of Neurosurgery, Children's Hospital of Philadelphia, Pennsylvania., Jenkins W; 13Department of Neurosurgery, Wake Forest Baptist Health, Winston-Salem, North Carolina., Tsering D; 14Department of Neurosurgery, Children's National Health System, Washington, DC., Price G; 15Department of Neurosurgery, Massachusetts General Hospital for Children, Boston, Massachusetts., Meola A; 16Department of Neurosurgery, Cleveland Clinic Children's, Cleveland, Ohio., Evanoff W; 16Department of Neurosurgery, Cleveland Clinic Children's, Cleveland, Ohio., Thompson EM; 17Department of Neurosurgery, Duke Children's Hospital, Durham, North Carolina., Brandmeir N; 18Department of Neurosurgery, Penn State Health, Hershey, Pennsylvania.
Jazyk:	angličtina
Zdroj:	Journal of neurosurgery. Pediatrics [J Neurosurg Pediatr] 2020 Mar 27; Vol. 26 (1), pp. 13-21. Date of Electronic Publication: 2020 Mar 27 (Print Publication: 2020).
DOI:	10.3171/2020.1.PEDS19496
Abstrakt:	Objective: This study aimed to assess the safety and efficacy of MR-guided stereotactic laser ablation (SLA) therapy in the treatment of pediatric brain tumors. Methods: Data from 17 North American centers were retrospectively reviewed. Clinical, technical, and radiographic data for pediatric patients treated with SLA for a diagnosis of brain tumor from 2008 to 2016 were collected and analyzed. Results: A total of 86 patients (mean age 12.2 ± 4.5 years) with 76 low-grade (I or II) and 10 high-grade (III or IV) tumors were included. Tumor location included lobar (38.4%), deep (45.3%), and cerebellar (16.3%) compartments. The mean follow-up time was 24 months (median 18 months, range 3-72 months). At the last follow-up, the volume of SLA-treated tumors had decreased in 80.6% of patients with follow-up data. Patients with high-grade tumors were more likely to have an unchanged or larger tumor size after SLA treatment than those with low-grade tumors (OR 7.49, p = 0.0364). Subsequent surgery and adjuvant treatment were not required after SLA treatment in 90.4% and 86.7% of patients, respectively. Patients with high-grade tumors were more likely to receive subsequent surgery (OR 2.25, p = 0.4957) and adjuvant treatment (OR 3.77, p = 0.1711) after SLA therapy, without reaching significance. A total of 29 acute complications in 23 patients were reported and included malpositioned catheters (n = 3), intracranial hemorrhages (n = 2), transient neurological deficits (n = 11), permanent neurological deficits (n = 5), symptomatic perilesional edema (n = 2), hydrocephalus (n = 4), and death (n = 2). On long-term follow-up, 3 patients were reported to have worsened neuropsychological test results. Pre-SLA tumor volume, tumor location, number of laser trajectories, and number of lesions created did not result in a significantly increased risk of complications; however, the odds of complications increased by 14% (OR 1.14, p = 0.0159) with every 1-cm3 increase in the volume of the lesion created. Conclusions: SLA is an effective, minimally invasive treatment option for pediatric brain tumors, although it is not without risks. Limiting the volume of the generated thermal lesion may help decrease the incidence of complications.
Databáze:	MEDLINE
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