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Management of incidental brain tumors in children: a systematic review

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Abstract

Background

Due to technical advancements and availability of neuroimaging, detection of incidental pediatric brain tumors (IPBT) is growing rapidly. The management of these asymptomatic lesions remains unclear; radiological, pathological, and clinical risk factors for further growth and malignant transformation (MT) are not well defined.

Methods

We systematically reviewed the literature on the dilemmas and management of IPBT suggestive of a low-grade brain tumor (LGBT). Keyword searches of the PubMed and Medline (NCBI) databases identified studies on IPBT describing the prevalence, neuroimaging, management, or risk of MT through July 2019. References of the identified articles were also reviewed.

Results

A total of 2021 records were screened. Fifty-nine full-text articles were reviewed, and 34 published studies were included. IPBT are diagnosed in 0.2–5.7% of children undergoing brain imaging for various reasons. The accepted approach for management of lesions showing radiological characteristics suggestive of LGBT is radiological follow-up. The rate at which additional intervention is required during follow-up for these apparently low-grade lesions is 9.5%. Nevertheless, the dilemma of early surgical resection or biopsy vs. clinical and radiological follow-up of IPBT is still unresolved. The risk in these cases is missing a transformation to a higher grade tumor. However, MT of pediatric LGBT is very rare, occurring in less than 3% of the cases of proven low-grade gliomas in children. The risk of future MT in pediatric low-grade gliomas seems to be greater in the presence of specific molecular markers such as BRAF V-600E, CDKN2A, and H3F3A K27M.

Conclusions

The natural history, management, and prognosis of IPBT remain ambiguous. It seems that lesions suggestive of LGBT can initially be followed, since many of these lesions remain stable over time and MT is rare. However, controversy among centers concerning the ideal approach still exists. Further observational and prospective cohort studies, focusing on potential clinical and radiological characteristics or risk factors suggestive of high-grade tumors, tumor progress, or MT of IPBT, are needed.

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Acknowledgments

We would like to thank Mrs. Adina Sherer for the medical proof reading of this manuscript.

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Authors and Affiliations

  1. Department of Pediatric Neurosurgery, Tel Aviv Medical Center & Dana Children’s Hospital Tel Aviv, Weizman Street 12, Tel Aviv, Israel

    Jehuda Soleman, Danil A. Kozyrev, Shlomi Constantini & Jonathan Roth

  2. Departments of Neurosurgery and Pediatric Neurosurgery, University Hospital and Children’s University Hospital of Basel, Basel, Switzerland

    Jehuda Soleman

  3. Faculty of Medicine, University of Basel, Basel, Switzerland

    Jehuda Soleman

  4. Department of Pediatric Neuroradiology, Tel Aviv Medical Center & Dana Children’s Hospital Tel Aviv, Tel Aviv, Israel

    Liat Ben-Sira

  5. Tel-Aviv University, Tel Aviv, Israel

    Shlomi Constantini & Jonathan Roth

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Soleman, J., Kozyrev, D.A., Ben-Sira, L. et al. Management of incidental brain tumors in children: a systematic review. Childs Nerv Syst 36, 1607–1619 (2020). https://doi.org/10.1007/s00381-020-04658-8

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