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Feasibility, safety, and indications for surgical biopsy of intrinsic brainstem tumors in children

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Abstract

Purpose

Diffuse intrinsic pontine gliomas (DIPGs) are rapidly progressive and aggressive tumors that usually arise in children. Their anatomic location makes gross total surgical resection impossible, and fewer than 10 % of patients survive more than 2 years after diagnosis. Often, these lesions are treated based on imaging characteristics alone. However, despite aggressive chemotherapy and radiation treatments available, prognosis remains poor. There is therefore a need for new therapies directed by biologic profiling. This necessitates a tissue diagnosis and, therefore, surgical biopsy. We have reviewed the results of biopsy for DIPGs in children at a single institution and compared our results to those available in the literature to elucidate the utility of biopsy for DIPGs.

Methods

A historical cohort study was performed using medical records of patients under the age of 18 who underwent surgical biopsy of a DIPG at a single institution.

Results

Nine patients were included, four males and five females. Age at presentation ranged from 8 months to 10 years (average 5.7 years). Pathologic diagnoses included five high grade (WHO grade III or IV) gliomas and four low grade (WHO grade II) astrocytomas. There were no intraoperative complications, and only one patient developed a new postoperative neurologic deficit.

Conclusions

Stereotactic biopsy of DIPGs is essential to obtain a pathologic diagnosis and is associated with low morbidity. This technique is important to elucidate biological characteristics of these tumors in order to direct multidisciplinary treatment plans possibly involving chemotherapy, radiation therapy, or other future clinical trial interventions for children with DIPGs.

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Disclosure

The authors report no conflict of interest concerning the materials or methods used in this study of the findings specified in this paper.

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Authors and Affiliations

  1. Department of Neurological Surgery, Pediatric Neurosurgery, University of California, San Francisco, 505 Parnassus Ave, Room M779, San Francisco, CA, 94143-0112, USA

    Tene A. Cage, Sonia P. Samagh, Sabine Mueller, Michael Prados, Kurtis I. Auguste & Nalin Gupta

  2. Division of Hematology and Oncology, Department of Pediatrics, University of California, 505 Parnassus Ave, San Francisco, CA, 94143, USA

    Sabine Mueller, Theodore Nicolaides, Anu Banerjee, Kurtis I. Auguste & Nalin Gupta

  3. Department of Radiation Oncology, University of California, 505 Parnassus Ave, San Francisco, CA, 94143-0226, USA

    Daphne Haas-Kogan

  4. Children’s Hospital and Research Center Oakland, 747 52nd St, Oakland, CA, 94609, USA

    Kurtis I. Auguste

Authors
  1. Tene A. Cage
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  2. Sonia P. Samagh
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Correspondence to Nalin Gupta.

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Cage, T.A., Samagh, S.P., Mueller, S. et al. Feasibility, safety, and indications for surgical biopsy of intrinsic brainstem tumors in children. Childs Nerv Syst 29, 1313–1319 (2013). https://doi.org/10.1007/s00381-013-2101-0

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  • DOI: https://doi.org/10.1007/s00381-013-2101-0

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