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Incidentally found brain tumors in the pediatric population: a case series and proposed treatment algorithm

  • Clinical Study
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Abstract

Purpose

With the increasing use of imaging, there has been an increase in the number of incidentally found brain lesions in pediatric patients resulting in a treatment dilemma for physicians and emotional strain for patients and families. Adult studies support initial surveillance of incidentally found low grade appearing lesions as the most appropriate approach. The aim of this study was to evaluate incidental lesions in the pediatric population and propose an initial treatment algorithm for such lesions.

Methods

Pediatric records were retrospectively reviewed at Johns Hopkins All Children’s Hospital for incidentally found brain tumors between 2000 and 2017. Demographic data, presenting symptoms, treatment approach, and outcomes were reviewed for 55 patients, age 0–18.

Results

Of the 55 patients included in the study, 14 underwent surgical resection, 3 underwent biopsy, and 38 with benign imaging characteristics at presentation were monitored with radiology alone. Only one patient, out of the 17 that underwent resection or biopsy, had pathology consistent with a high grade glioma. Of the patients monitored radiographically 10 total patients showed an increase in the overall size of the lesion; however after a median follow up of 34.2 months only 2 increased to a degree that required surgical intervention.

Conclusions

The majority of incidentally found brain lesions with benign imaging characteristics at presentation may be managed conservatively. Surveillance is an important part of the initial management of incidental lesions in the pediatric population, but careful scrutiny must be paid to the potential for higher grade lesions or malignant transformation.

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Authors and Affiliations

  1. Department of Hematology Oncology, Akron Children’s Hospital, 1 Perkins Square, Akron, OH, 44308, USA

    Erin Wright

  2. Department of Pediatrics, University of South Florida, 501 6th Ave S, St Petersburg, FL, 33701, USA

    Erin Wright

  3. Cancer and Blood Disorders Institute, Johns Hopkins All Children’s Hospital, 501 6th Ave S, St Petersburg, FL, 33701, USA

    Ernest K. Amankwah & Stacie Stapleton

  4. Neuroscience Institute, Johns Hopkins All Children’s Hospital, 501 6th Ave S, St Petersburg, FL, 33701, USA

    S. Parrish Winesett

  5. Institute of Brain Protection Sciences, Johns Hopkins All Children’s Hospital, 501 6th Ave S, St Petersburg, FL, 33701, USA

    Gerald F. Tuite, George Jallo & Carolyn Carey

  6. Pediatric Neurosurgery, Institute of Brain Protection Sciences, Johns Hopkins All Children’s Hospital, 501 6th Ave S, St Petersburg, FL, 33701, USA

    Luis F. Rodriguez

Authors
  1. Erin Wright
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  2. Ernest K. Amankwah
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  3. S. Parrish Winesett
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  4. Gerald F. Tuite
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  5. George Jallo
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  6. Carolyn Carey
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  7. Luis F. Rodriguez
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  8. Stacie Stapleton
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Corresponding author

Correspondence to Erin Wright.

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No authors have any conflict of interest to report.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Wright, E., Amankwah, E.K., Winesett, S.P. et al. Incidentally found brain tumors in the pediatric population: a case series and proposed treatment algorithm. J Neurooncol 141, 355–361 (2019). https://doi.org/10.1007/s11060-018-03039-1

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  • DOI: https://doi.org/10.1007/s11060-018-03039-1

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