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59th Annual Meeting of the German Society of Neurosurgery (DGNC)
3rd Joint Meeting with the Italian Neurosurgical Society (SINch)

German Society of Neurosurgery (DGNC)

1 - 4 June 2008, Würzburg

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Treatment concepts for pediatric low-grade gliomas in critical locations

Behandlungskonzepte für Kinder mit niedermalignen Gliomen in kritischer Lokalisation

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  • corresponding author A. Peraud - Neurochirurgische Klinik und Poliklinik, Klinikum Großhadern, Ludwig-Maximilians-Universität, München
  • S. Grau - Neurochirurgische Klinik und Poliklinik, Klinikum Großhadern, Ludwig-Maximilians-Universität, München
  • J.-C. Tonn - Neurochirurgische Klinik und Poliklinik, Klinikum Großhadern, Ludwig-Maximilians-Universität, München
  • F. W. Kreth - Neurochirurgische Klinik und Poliklinik, Klinikum Großhadern, Ludwig-Maximilians-Universität, München

Deutsche Gesellschaft für Neurochirurgie. Società Italiana di Neurochirurgia. 59. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), 3. Joint Meeting mit der Italienischen Gesellschaft für Neurochirurgie (SINch). Würzburg, 01.-04.06.2008. Düsseldorf: German Medical Science GMS Publishing House; 2008. DocMO.09.04

The electronic version of this article is the complete one and can be found online at: http://www.egms.de/en/meetings/dgnc2008/08dgnc094.shtml

Published: May 30, 2008

© 2008 Peraud et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

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Objective: In search of optimized treatment conditions for children with WHO grade I and II gliomas not accessible to complete resection, radiosurgery has been proven to be beneficial. Interstitial radiosurgery with temporary Iodine-125-seeds provides precise radiosurgical planning sparing surrounding normal tissue. The results in 19 pediatric cases, in whom microsurgery was combined with IRS or who received IRS alone, are demonstrated.

Methods: Twelve boys and 7 girls with low-grade gliomas were included in the present study. Mean age at the time of seed implantation was 9 years (range 11 months to 16 years). Tumour location was hypothalamic / suprasellar in 6, lobar in 5, deep (basal ganglia, pineal gland) in 4, and within the brainstem in 4 children. Histology revealed 13 pilocytic astrocytomas, 6 fibrillary astrocytomas. Partial resection with subsequent IRS was performed in 9 cases, 10 tumours were stereotactically biopsied and implanted with Iodine-125-seeds.

Results: Mean follow-up time was 26 months. Five tumours showed complete regression 9 to 40 months after seed implantation, tumours decreased in size in 11 children 2 to 16 months after IRS. Two children developed space occupying radionecrosis which had then to be resected leading to neurological improvement. One boy died due to tumour progression of his WHO grade II astrocytoma. Nine children even experienced an improvement of their previous deficits.

Conclusions: Stereotactic radiosurgery is a safe and effective method even in the younger patient group under 3 years of age. Microsurgery in combination with IRS or IRS as single treatment provides excellent surgical outcome, good tumour control and low morbidity.