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Differenzialdiagnose infratentorieller Hirntumoren bei Kindern

  • Pädiatrische Neuroradiologie
  • Published:
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Zusammenfassung

Bei Kindern kommen in der ersten Lebensdekade mit Ausnahme des ersten Lebensjahrs besonders häufig infratentorielle Hirntumoren vor. Es handelt sich in absteigender Häufigkeit um niedriggradige Astrozytome des Kleinhirns, Medulloblastome, Hirnstammgliome und Ependymome des IV. Ventrikels. Die Differenzialdiagnose dieser Tumoren ist durch Beachtung der Lokalisation und Morphologie in MRT und CT sowie durch Berücksichtigung des Ausbreitungsmusters sehr häufig möglich. Für die Planung der Behandlung sind besonders bei malignen, zu einer Meningeose neigenden Hirntumoren Kenntnisse über das Ausmaß einer evtl. Dissemination erforderlich, sodass nicht nur kranielle, sondern auch spinale MRT-Untersuchungen zum Staging unerlässlich sind. Unmittelbar postoperativ können ausschließlich operationsbedingte Veränderungen in Form einer Kontrastmittelaufnahme im spinalen subduralen Raum auftreten, die mit einer Meningeose verwechselt werden könnten. Anhand typischer Bilder werden die Morphologie und die Differenzialdiagnose der infratentoriellen Tumoren im Kindesalter und des unspezifischen postoperativen subduralen Enhancements demonstriert.

Abstract

With the exception of the first year of life, infratentorial brain tumors are more frequent in the first decade than tumors in the supratentorial compartment. In particular these are cerebellar low-grade astrocytomas, medulloblastomas, brainstem gliomas and ependymomas of the fourth ventricle. The morphology on MRI and CT and the mode of dissemination permit differential diagnosis in many cases. To allow correct stratification into different treatments in possibly disseminating malignant brain tumors, knowledge of the status of dissemination is essential, and therefore not only cranial but also spinal MRI is indispensable for staging. If the spinal MRI is performed in the immediate postoperative period, knowledge of the normal non-specific purely postoperative changes, often seen as enhancement in the subdural spinal spaces, is necessary in order to avoid misinterpretation as meningial seeding. The differential diagnosis of pediatric infratentorial brain tumors and the morphology of subdural enhancement are illustrated with typical images. The natural history of the most frequent tumors and its importance for treatment decisions is discussed in light of the literature.

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Literatur

  1. Albright AL (1996) Diffuse brainstem tumors: when is a biopsy necessary? Pediatr Neurosurg 24: 252–255

    CAS  PubMed  Google Scholar 

  2. Albright AL, Packer RJ, Zimmerman R, Rorke LB, Boyett J, Hammond D (1993) Magnetic resonance scans should replace biopsy for the diagnosis of diffuse brain stem gliomas: a report from the Children’s Cancer Group. Neurosurgery 33: 1026–1030

    CAS  PubMed  Google Scholar 

  3. Barkovich JA (2000) Techniques of imaging pediatric brain tumors. In: Bakovich JA (ed) Pediatric neuroimaging. Lippincott, Williams & Wilkins, Philadelphia, pp 445–446

  4. Barkovich AJ, Krischer J, Kun LE, Paker R, Zimmerman RA, Freeman CR, Wara WM, Albright L, Allen JC, Hoffman HJ (1991) Brain stem gliomas: a classification system based on magnetic resonance imaging. Pediatr Neurosurg 16: 73–83

    CAS  Google Scholar 

  5. Bronciser A, Gajjar A, Bhargava R, Langston JW, Heideman R, Jones D, Kun LE, Taylor J (1997) Brain stem involvement in children with neurofibromatosis type I: role of magnetic resonance imaging and spectroscopy in the distinction from diffuse pontine glioma. Neurosurgery 40: 331–338

    PubMed  Google Scholar 

  6. Burger PC (1996) Pathology of brain stem astrocytomas. Pediatr Neurosurg 24: 35–40

    CAS  PubMed  Google Scholar 

  7. Burger PC, Scheithauer BW, Paulus W, Szymas J, Giannini C, Kleihues P (2000) Pilocytic astrocytomas. In: Kleihues P Cavanee WK (eds) Tumours of the central nervous system. IARC Press, Lyon, pp 45–51

  8. Chang T, Teng MMH, Lirng JF (1993) Posterior fossa tumours in childhood. Neuroradiology 35: 274–278

    CAS  PubMed  Google Scholar 

  9. Constantini S, Siomin V, Sherer A, Epstein F (1998) Pontine gliomas: a lesson to learn. Neuropediatrics 29: 282–283

    CAS  PubMed  Google Scholar 

  10. Ferrante L, Mastronardi L, Schettini G, Lumardi P, Fortuna A (1994) Fourth ventricle ependymomas. A study of 20 cases with survival analysis. Acta Neurochir (Wien) 131: 67–74

    Google Scholar 

  11. Giangaspero F, Bigner SH, Kleihues P, Pietsch T, Trojanowski JQ (2000) Medulloblastoma. In: Kleihues P, Cavanee WK (eds) Tumours of the central nervous system. IARC Press, Lyon, pp 129–137

  12. Kaplan AM, Albright LA, Zimmerman RA, Rorke LB, Li H, Boyett JM, Finlay JL, Wara WM, Packer RJ (1996) Brainstem gliomas in children. Pediatr Neurosurg 24: 185–192

    CAS  PubMed  Google Scholar 

  13. Kovar E, Kun L,Krischer J (1991) Patterns of dissemination and recurrence in childhood ependymoma: preliminary results of the Pediatric Oncology Group, protocol 8532. Ann Neurol 30: 457

    Google Scholar 

  14. Levy RA, Blaivas M, Murasko K, Robertson PL (1996) Desmoplastic medulloblastoma: MR findings. AJNR Am J Neuroradiol 18: 1364–1366

    Google Scholar 

  15. Meyers SP, Kemp SS, Tarr RW (1992) MR imaging features of medulloblastomas. AJR Am J Roentgenol 158: 859–865

    CAS  PubMed  Google Scholar 

  16. Nagib MG, O’Fallon MT (1996) Posterior fossa lateral ependymoma in childhood. Pediatr Neurosurg 24: 299–305

    CAS  PubMed  Google Scholar 

  17. OsbornAG (1994) Brain tumors and tumor like processes: astrocytomas and other glial neoplasms. In: Osborn AG (ed) Diagnostic neuroradiology. Mosby, St Louis, pp 553–558

  18. OsbornAG, Rauschning W (1994) Brain tumors and tumor like processes: classification and differential diagnosis. In: Osborn AG (ed) Diagnostic neuroradiology. Mosby, St Louis, pp 401–408

  19. Packer R (1990) Chemotherapy for medulloblastoma/primitive neuroectodermal tumors of the posterior fossa. Ann Neurol 28: 823–828

    CAS  PubMed  Google Scholar 

  20. Packer RJ (1999) Childhood medulloblastoma: progress and future challenges. Brain Dev 21: 75–81

    Article  CAS  PubMed  Google Scholar 

  21. Perilongo G, Garre ML, Giangaspero F (2003) Low-grade gliomas and leptomeningeal dissemination: a poorly understood phenomenon. Childs Nerv Syst 19: 197–203

    PubMed  Google Scholar 

  22. Poussaint TY, Kowal JR, Barnes PD, Zurakowski D, Anthony DC, Goumnerova L, Tarbell NJ (1998) Tectal tumors of childhood: clinical and imaging follow-up. AJNR Am J Neuroradiol 19: 977–983

    CAS  PubMed  Google Scholar 

  23. Poussaint TY, Yousuf N, Barnes PD, Anthony DC, Zurakowski D, Scott M, Tarbell NJ (1999) Cervicomedullary astrocytomas of childhood: clinical and imaging follow-up. Pediatr Radiol 29: 662–668

    Article  PubMed  Google Scholar 

  24. Shaw DWW, Weinberger E, Brewer DK, Geyer JR, Berger MS, Blaser SI (1996) Spinal subdural enhancement after suboccipital craniectomy. AJNR Am J Neuroradiol 17: 1373–1377

    CAS  PubMed  Google Scholar 

  25. Scheurlen W, Kühl J (1998) Current diagnostic and therapeutic management of CNS metastasis in childhood primitive neuroectodermal tumors and ependymomas. J Neurooncol 38: 181–185

    Article  CAS  PubMed  Google Scholar 

  26. Tortori-Donati P, Fondelli MP, Cama A, Garre ML, Rossi A, Andreussi L (1995) Ependymomas of the posterior cranial fossa: CT and MRI findings. Neuroradiology 37: 238–243

    Article  CAS  PubMed  Google Scholar 

  27. Warmuth-Metz M, Kühl J (2002) Neuroradiologie bei Medulloblastomen in Differenzialdiagnose zu Ependymomen: Ergebnisse der HIT’91-Studie. Klin Pädiatr 214: 162–166

    Google Scholar 

  28. Warmuth-Metz M, Kühl J, Solymosi L (2002) Imaging in medulloblastoma: golden standard, reality and pitfalls. Med Pediatr Oncol 39: 273

    Google Scholar 

  29. Warmuth-Metz M, Wolff J, Wagner S, Solymosi L (2002) Characteristics on MRI in pontine glioma. Med Pediatr Oncol 39: 373

    Google Scholar 

  30. Wiener MD, Boyko OB, Friedman HS, Hockenberger B, Oakes WJ (1990) False-positive spinal MR findings for subarachnoid spread of primary CNS tumor in postoperative pediatric patients. AJNR Am J Neuroradiol 11: 1100–1103

    CAS  PubMed  Google Scholar 

  31. Zimmerman R (1996) Neuroimaging of primary brainstem gliomas: diagnosis and course. Pediatr. Neurosurg 25: 45–53

    CAS  Google Scholar 

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Authors and Affiliations

  1. Abteilung für Neuroradiologie, Universität Würzburg

    M. Warmuth-Metz & L. Solymosi

  2. Pädiatrische Onkologie, Universität Würzburg

    J. Kühl & S. Rutkowski

  3. Pädiatrische Neurochirurgie, Universität Würzburg

    J. Krauß

  4. Abteilung für Neuroradiologie, Universität Würzburg, Josef-Schneider-Straße 11, 97080 , Würzburg

    M. Warmuth-Metz

Authors
  1. M. Warmuth-Metz
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  2. J. Kühl
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  3. S. Rutkowski
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  4. J. Krauß
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  5. L. Solymosi
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Correspondence to M. Warmuth-Metz.

Additional information

Das Referenzzentrum für Neuroradiologie der HIT-Studien der GPOH in Würzburg (Leitung: Priv.-Doz. Dr. M. Warmuth-Metz) wird gefördert durch die Deutsche Kinderkrebsstiftung.

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Warmuth-Metz, M., Kühl, J., Rutkowski, S. et al. Differenzialdiagnose infratentorieller Hirntumoren bei Kindern. Radiologe 43, 977–985 (2003). https://doi.org/10.1007/s00117-003-0970-z

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  • DOI: https://doi.org/10.1007/s00117-003-0970-z

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