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Pediatric posterior fossa incidentalomas

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Abstract

Purpose

Pediatric brain incidentalomas are increasingly being diagnosed. As the posterior fossa (PF) is the location of most brain tumors in children, lesions of this region are of special interest. Currently, the natural history of incidental lesions in the PF is unknown. We present our experience treating such lesions.

Methods

A retrospective study was carried out in two large tertiary pediatric centers. Patients were included if they had an incidental PF lesion suspected of being a tumor, and diagnosed before the age of 20 years. We analyzed treatment strategy, pathology, and outcome of operated and non-operated cases.

Results

Seventy children (31 females) with a mean age of 8.4 ± 6.1 years were included. The three most common indications for imaging were headaches (16, assumed to be unrelated to the lesions), workup of unrelated conditions (14), and unspecified reasons (14). Twenty-seven patients (39%) were operated immediately, and 43 followed, of which 12 were eventually operated due to radiological changes, 28.9 ± 16.2 months after diagnosis. The most commonly found pathology was pilocytic astrocytomas (21 of 39 operated cases). Almost 10% were found to be malignant tumors including medulloblastomas (5) and ATRT (1).

Conclusion

Incidental PF lesions in children include both benign and malignant tumors. While certain lesions may be followed, others may require surgical treatment. Specific treatment decisions are based on initial radiological appearance, change in radiological characteristics over time, location, and evolving symptoms. The surgical risks must be balanced vis-à-vis the risk of missing a high-grade tumor and the very rare risk of malignant transformation.

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Acknowledgments

We would like to thank Yaroslava A. Kozyreva for the drawing in this article, and Mrs. Adina Sherer for linguistic editing.

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Authors and Affiliations

  1. Department of Pediatric Neurosurgery, Dana Children’s Hospital, Tel Aviv Medical Center, Tel Aviv University, 6 Weizmann Street, 64239, Tel Aviv, Israel

    Danil A. Kozyrev, Shlomi Constantini, Sharif Basal & Jonathan Roth

  2. Children’s National Medical Center, Washington, DC, USA

    Deki Tsering & Robert Keating

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  1. Danil A. Kozyrev
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  2. Shlomi Constantini
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Correspondence to Jonathan Roth.

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Kozyrev, D.A., Constantini, S., Tsering, D. et al. Pediatric posterior fossa incidentalomas. Childs Nerv Syst 36, 601–609 (2020). https://doi.org/10.1007/s00381-019-04364-0

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