Abstract
Purpose
Given the rarity of disseminated disease at the time of initial evaluation for pediatric brain tumor patients, we sought to identify clinical and radiographic predictors of spinal metastasis (SM) at the time of presentation.
Methods
We performed a single-institution retrospective chart review of pediatric brain tumor patients who first presented between 2004 and 2018. We extracted information regarding patient demographics, radiographic attributes, and presenting symptoms. Univariate and multivariate logistic regression was used to estimate the association between measured variables and SMs.
Results
We identified 281 patients who met our inclusion criteria, of whom 19 had SM at initial presentation (6.8%). The most common symptoms at presentation were headache (n = 12; 63.2%), nausea/vomiting (n = 16; 84.2%), and gait abnormalities (n = 8; 41.2%). Multivariate models demonstrated that intraventricular and posterior fossa tumors were more frequently associated with SM (OR: 5.28, 95% CI: 1.79–15.59, p = 0.003), with 4th ventricular (OR: 7.42, 95% CI: 1.77–31.11, p = 0.006) and cerebellar parenchymal tumor location (OR: 4.79, 95% CI: 1.17–19.63, p = 0.030) carrying the highest risk for disseminated disease. In addition, evidence of intracranial leptomeningeal enhancement on magnetic resonance imaging (OR: 46.85, 95% CI: 12.31–178.28, p < 0.001) and hydrocephalus (OR: 3.19; 95% CI: 1.06–9.58; p = 0.038) were associated with SM.
Conclusions
Intraventricular tumors and the presence of intracranial leptomeningeal disease were most frequently associated with disseminated disease at presentation. These findings are consistent with current clinical expectations and offer empirical evidence that heightened suspicion for SM may be prospectively applied to certain subsets of pediatric brain tumor patients at the time of presentation.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
Data availability
All data generated or analyzed during this study are included in this article. Further inquiries can be directed to the corresponding author.
References
Buch K, Caruso P, Ebb D, Rincon S (2018) Balanced steady-state free precession sequence (CISS/FIESTA/3D Driven Equilibrium Radiofrequency Reset Pulse) increases the diagnostic yield for spinal drop metastases in children with brain tumors. AJNR Am J Neuroradiol 39(7):1355–1361
Nguyen TK, Nguyen EK, Soliman H (2020) An overview of leptomeningeal disease. Annals Palliative Med
Roth J, Fischer N, Limbrick DD, CreveCoeur T, Ben-Sira L, Constantini S (2019) The role of screening spinal MRI in children with solitary posterior fossa low-grade glial tumors. JNS Peds 25(2):106
Goyal A, Cajigas I, Ibrahim GM et al (2018) Surgical treatment of intramedullary spinal metastasis in medulloblastoma: case report and review of the literature. World Neurosurg 118:42–46
Alyeldien A, Teuber-Hanselmann S, Cheko A, Höll T, Scholz M, Petridis AK (2016) Diffuse spinal leptomeningeal spread of a pilocytic astrocytoma in a 3-year-old child. Clinics and practice 6(1):813
Jeong YB, Wang KC, Phi JH et al (2016) A case of nongerminomatous germ cell tumor with fulminant course concomitant leptomeningeal metastasis. Brain tumor research and treatment 4(1):21–25
Lassaletta A, Perez-Olleros P, Scaglione C et al (2007) Successful treatment of intracranial ependymoma with leptomeningeal spread with systemic chemotherapy and intrathecal liposomal cytarabine in a two-year-old child. J Neurooncol 83(3):303–306
Chen-Zhao X, Aznar-García L (2018) Diagnosis and management of spinal metastasis of primary brain tumours. AME case reports 2:26
Munshey A, Moore J, Maclean C, Longano A, Goldschlager T (2017) Cranial pilocytic astrocytoma with spinal drop metastasis in an adult: case report and literature review. World Neurosurg 98:883.e887-883.e812
Howlett DC, King AP, Jarosz JM et al (1997) Imaging and pathological features of primary malignant rhabdoid tumours of the brain and spine. Neuroradiology 39(10):719–723
Giese A, Westphal M (1996) Glioma invasion in the central nervous system. Neurosurgery 39:235–252
Lawton CD, Nagasawa DT, Yang I, Fessler RG, Smith ZA (2012) Leptomeningeal spinal metastases from glioblastoma multiforme: treatment and management of an uncommon manifestation of disease. J Neurosurg Spine 17(5):438–448
Meyers SP, Khademian ZP, Biegel JA, Chuang SH, Korones DN, Zimmerman RA (2006) Primary intracranial atypical teratoid/rhabdoid tumors of infancy and childhood: MRI features and patient outcomes. AJNR Am J Neuroradiol 27(5):962–971
Hussain IZ, MohdZaki F, Mukari SA, MdPauzi SH, Loh CK, Alias H (2020) Correlation between MRI characteristics of medulloblastoma with histopathological subtypes and 2-year survival. Indian J Radiol Imaging 30(1):46–51
Eom KS, Kim HS, Kim TY, Kim JM (2009) Intraventricular malignant meningioma with CSF-disseminated spinal metastasis : case report and literature review. Jo Korean Neurosurg Soc 45(4):256–259
Wells EM, Packer RJ (21015) Pediatric brain tumors. Continuum (Minneapolis, Minn) 21(2 Neuro-oncology):373–396
Prasad KSV, Ravi D, Pallikonda V, Raman BVS (2017) Clinicopathological study of pediatric posterior fossa tumors. J Pediatr Neurosci 12(3):245–250
Millard NE, De Braganca KC (2016) Medulloblastoma. J Child Neurol 31(12):1341–1353
Author information
Authors and Affiliations
Contributions
Adrian Rodrigues — patient chart review, data analysis and manuscript preparation, manuscript revision and submission. Zack Medress — project supervision, patient chart review, manuscript writing, manuscript revision. Jamasb Sayadi — patient chart review, data analysis, manuscript revision. Hriday Bhambhvani — patient chart review, data analysis, manuscript revision. Sam Falkson — patient chart review, data analysis, manuscript revision. Rayyan Jokhai — patient chart review, data analysis, manuscript revision. Summer Han — data analysis, manuscript writing, manuscript revision, project supervision. David Hong — project supervision, manuscript writing, manuscript revision.
Corresponding author
Ethics declarations
Ethics approval and consent to participate
This study protocol was reviewed and approved by Stanford University’s School of Medicine Institutional Review Board (protocol no. 48055). The study was exempt from patient consent because the information collected included only pre-existing, de-identified data, per the IRB of Stanford University’s School of Medicine.
Consent for publication
All the authors have reviewed the manuscript and consent to publication of the included materials in full. The study was exempt from patient consent because the information collected included only pre-existing, de-identified data, per the IRB of Stanford University’s School of Medicine.
Conflict of interest
The authors have no conflicts of interest or competing interests to declare.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Supplementary Information
Below is the link to the electronic supplementary material.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Rodrigues, A.J., Medress, Z.A., Sayadi, J. et al. Predictors of spine metastases at initial presentation of pediatric brain tumor patients: a single-institution study. Childs Nerv Syst 39, 603–608 (2023). https://doi.org/10.1007/s00381-022-05702-5
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00381-022-05702-5