gms | German Medical Science

Objective: For our youngest pediatric patients the use of a stereotactic frame is still controversial. In a retrospective study we analyzed the medical records of these patients.

Methods: Since 1990 a total of 928 children (mean age 9.89 years) underwent 1650 frame based stereotactic procedures, thereof 521 procedures in children under the age of 7 (mean 3.48 years), 44 in their first year of life.

Results: 815 biopsies were done, 269 under 7 years, 29 in the first year. The most frequent histopathological diagnoses were 555 pilocytic astrocytoma, 321 astrocytoma, 84 anaplastic astrocytoma, 69 craniopharyngioma, 36 germinoma and 26 ependymoma. Brain tumor was present in 83 % of the children. 232 cyst punctures were done, 177 Rickham catheters implanted. 326 Iodine-125 seed implantations in 314 patients (mean 8.87 years) were done, 106 under 7 years, 6 in the first year, with a biopsy at the same time in 255 patients. 281 electrodes were implanted for epilepsy diagnostics in 66 patients, 28 electrodes for deep brain stimulation in 14 patients. The most frequent given sites are the diencephalon 54%, basal ganglia 19%, frontal lobe 14%, brainstem 11% and hypothalamus 8%. No neurological deficit was related to pin fixation, no air embolism, no pin related infection, no CSF leak. In the group under 7 years the overall complication rate was 5%: pin penetration 3%, skull fractures 2% (Furlanetti L et al.)

Conclusion: Frame based stereotactic surgery and stereotactic interstitial radiosurgery with Iodine-125 seeds are safe and useful options for diagnosis and treatment of benign and malignant intracranial lesions, especially if they are small, deep-seated or difficult to approach for open microsurgery or when other restrictions apply: like the age for external fractionated radiotherapy.