Artikel
Neuroblastoma with association to central nervous system (CNS) – the need for neurosurgery – a single-centre analysis of 237 patients
Neuroblastom und Assoziation zum ZNS – Bedarf neurochirurgischer Eingriffe – Single-Centre-Analyse von 237 Patienten
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Autoren
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Steffen K. Fleck
- Universitätsmedizin Greifswald, Klinik für Neurochirurgie, Greifswald, Deutschland
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Clara Bobak
- Universitätsmedizin Greifswald, Klinik für Neurochirurgie, Greifswald, Deutschland
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Sascha Marx
- Universitätsmedizin Greifswald, Klinik für Neurochirurgie, Greifswald, Deutschland
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Silke Kietz
- Universitätsmedizin Greifswald, Klinik für Neurochirurgie, Greifswald, Deutschland; Universitätsmedizin Greifswald, Klinik für Pädiatrische Onkologie, Greifswald, Deutschland
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Karoline Ehlert
- Universitätsmedizin Greifswald, Klinik für Pädiatrische Onkologie, Greifswald, Deutschland
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Nikolai Siebert
- Universitätsmedizin Greifswald, Klinik für Pädiatrische Onkologie, Greifswald, Deutschland
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Victoria Richter
- Universitätsmedizin Greifswald, Klinik für Neurochirurgie, Greifswald, Deutschland
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Holger Lode
- Universitätsmedizin Greifswald, Klinik für Pädiatrische Onkologie, Greifswald, Deutschland
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Henry W. S. Schroeder
- Universitätsmedizin Greifswald, Klinik für Pädiatrische Onkologie, Greifswald, Deutschland
| Veröffentlicht: | 8. Mai 2019 |
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Gliederung
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Objective: Neuroblastoma is a common malignancy in childhood. Improved therapies did increase overall survival during the last decade leading to more distant metastases. Neurosurgical experience with neuroblastoma metastasis is limited. The aim of the present study was to evaluate the frequency of neuroblastoma metastases in spine and cranium.
Methods: All neuroblastoma patients of the local department of pediatric oncology between 2009 and 2018 were analyzed retrospectively. A comprehensive chart review was performed. We focused on the occurrence of metastases with neurosurgical relevance. Survival data were obtained by phone calls with the families/ general practitioners.
Results: 237 patients could be included into the study (94 girls, 143 boys, mean age at first diagnosis 39 months, 1 to 395 months). The primary tumor was in most cases in the abdomen. 194/536 metastases were in the skull or brain. 9/194 patients suffered from meningeosis carcinomatosa. 147/194 metastases were located in the calotte or skull base exclusively. 23/194 metastasis were purely intracerebral. 15/194 metastasis did develop out of the bone, but made significant epidural masses and/or dura infiltration.
336/536 metastasis were located in the spine (13.8% cervical, 31.5% thoracic, 31.8% lumbar, 22.2% sacral).
Neurosurgical resection of metastases was performed in 32 patients (53% skull/brain and 47% spine). Indications for surgery were mass effect of the lesion and neurological deficits. The neurological status did improve in 8 patients after surgery, deteriorated in 6 patients and was unchanged in all others. Postoperative radiation therapy was applied in 9 patients. Mean overall survival was 17.5 months after neurosurgical resection.
Conclusion: Neuroblastoma metastases frequently occur in the skull/ brain, and spine and seem to be a characteristic manifestation in advanced/relapsed stage disease. Mass effect and/ or neurological deficits were indications for neurosurgical resection. Overall survival after surgery was very limited, most likely due to the stage of the disease. The best therapy (surgical versus non-surgical) for neuroblastoma metastasis of neurosurgical relevance needs to be evaluated in further studies.
