Article
Feasibility and safety of open microsurgical approach in pediatric diffuse intrinsic glioma
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Authors
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Nicolai El Hindy
- Universitätsklinikum Essen der Universität Duisburg-Essen, Klinik und Poliklinik für Neurochirurgie, Essen, Deutschland
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Thiemo-Florin Dinger
- Essen, Deutschland
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Elias Lemonas
- Essen, Deutschland
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Karsten Wrede
- Essen, Deutschland
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Daniela Pierscianek
- Essen, Deutschland
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Ulrich Sure
- Essen, Deutschland
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Oliver Müller
- Essen, Deutschland
| Published: | June 9, 2017 |
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Outline
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Objective: Diffuse intrinsic pontine glioma (DIPG) is the most common brainstem tumor of childhood. As the opportunity of molecular diagnostics revealed intense histopathological heterogeneity of DIPGs and their different response to adjuvant therapy, biopsy is of rising interest. Biopsy is often performed by means of stereotactic procedures. Whenever suitable, we perform open, microsurgical procedures. Hence, our aim was to evaluate the feasibility and complications of this approach.
Methods: All children operated for DIPG from 2001-2016 were included. Clinical data were analyzed with special respect to age, sex, and tumor location. Operative records were evaluated, regarding positioning, intra-/postoperative complications, onset of new neurological deficits, operative approach, neurophysiological monitoring and histopathological results. Descriptive statistics were used, to reveal differences.
Results: 10 patients could be included in this study. Median age at diagnosis was 7.5 years (range 2 – 16). All children, except one operated by stereotactic biopsy, were operated by an open, microsurgical procedure (n=9) in the semi-sitting position. Electrophysiological monitoring was utilized in all cases. 6 children were operated by a retrosigmoid, 3 by a median suboccipital, telo-velo-medullary approach. There were no intraoperative complications. One child developed a CSF fistula with mastoiditis, which had to be re-operated. There was no onset of new neurological deficits. Tumor material for pathohistological workup and reference evaluation could be collected in all nine patients. DIPG proofed to be heterogeneous with 3 children suffering from WHO°IV, 3 children WHO°III and 3 children WHO°II tumor.
Conclusion: Open, microsurgical approach to DIPG in the semisitting position with electrophysiological monitoring is safe and warrants collection of sufficient tumor material for differential histological workup. Histology results reveal DIPG as heterogeneous tumors varying in WHO degree.
