Paediatric posterior fossa tumour resection rates in a small volume centre: the past decade’s experience

Bhatt, Harsh; Bhatti, Muhammad Imran; Patel, Chirag; Leach, Philip

doi:10.1080/02688697.2020.1859085

Cited by 5 publications

(3 citation statements)

References 32 publications

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“…According to recent published data by different international groups ( 10 , 34 – 38 ), GTR was achievable in about half of the patients operated with white-light illumination (53.81%). In this perspective, the application of new technical tools aimed at improving the EOR could be beneficial in the management of PAs.…”

Section: Discussionmentioning

confidence: 99%

Fluorescein-guided surgery for the resection of pilocytic astrocytomas: A multicentric retrospective study

et al. 2022

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ObjectivePilocytic astrocytomas (PAs) are relatively benign tumors, usually enhancing on post-contrast MRI and often characterized by a mural nodule within a cystic component. Surgical resection represents the mainstay of treatment, and extent of resection (EOR) is associated with improved survival. In this study, we analyzed the effect of sodium fluorescein (SF) on the visualization and resection of these circumscribed astrocytic gliomas.MethodsSurgical databases at two neurosurgical departments (Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy and Department of Neurosurgery, University Medical Center Regensburg, Regensburg, Germany) were retrospectively reviewed to identify the cohort of patients with pilocytic astrocytoma who had undergone fluorescein-guided tumor resection at any of the centers between March 2016 and February 2022. SF was intravenously injected (5 mg/kg) immediately after the induction of general anesthesia. Tumors were removed using a microsurgical technique with the YELLOW 560 filter (Carl Zeiss Meditec, Oberkochen, Germany).ResultsForty-four patients (25 males and 19 females; 26 pediatric patients, mean age of 9.77 years, range 2 to 17 years; and 18 adult patients, mean age of 34.39 years, range 18 to 58 years) underwent fluorescein-guided surgery. No side effects related to SF occurred. In all tumors, contrast enhancement on preoperative MRI was correlated with intense, heterogeneous yellow fluorescence with bright fluorescent cystic fluid. Fluorescein was considered helpful in distinguishing tumors from viable tissue in all cases except three patients due to faint fluorescein enhancement. Biopsy was intended in two operations, and partial resection was intended in three operations. Gross total resection was achieved in 24 cases out of 39 patients scheduled for tumor removal (61.54%), in five cases a minimal residual volume was highlighted by postoperative MRI despite the intraoperative subjective evaluation of complete tumor removal (12.82%); in the other 10 cases, the resection was subtotal with fluorescent residual spots to avoid neurological worsening (25.64%).ConclusionsThe use of SF is a valuable method for safe fluorescence-guided tumor resection. Our data showed a positive effect of fluorescein-guided surgery on intraoperative visualization during resection of Pas, suggesting a possible role in improving the extent of resection of these lesions.

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Section: Discussionmentioning

confidence: 99%

Fluorescein-guided surgery for the resection of pilocytic astrocytomas: A multicentric retrospective study

et al. 2022

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“…In contrast with most cohorts around PA in children that mainly investigate recurrence and overall survival ( Villanueva et al, 2019 , Park et al, 2019 , Fernandez et al, 2003 , Bernhardtsen et al, 2003 , Hayostek et al, 1993 , Bhatt et al, 2021 ), our study focused on neurological outcome after second-look surgery. This, given the above mentioned important indirect correlation between partial resection and prognosis ( Villanueva et al, 2019 , Fernandez et al, 2003 , Ogiwara et al, 2012 , Hayostek et al, 1993 ).…”

Section: Discussionmentioning

confidence: 99%

Long-term outcome after management of pilocytic astrocytoma in the posterior fossa in a pediatric population

Santo

Dieckmann

Rauschenbach

et al. 2022

IBRO Neuroscience Reports

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“…Compared to EOR rates in the literature concerning tumors in the posterior fossa in children, we did not see a significant difference. For instance, in a study by Bhatt et al, GTR complete resection rates for pilocytic astrocytomas, medulloblastomas, and ependymomas were 77%, 79%, and 63% without FL guidance [ 26 ]. In contrast to the aforementioned study, our study population is very heterogenous, and the patients were suffering from different entities of tumors in variable localizations (e.g., rhomboid fossa and pineal region), potentially leading to a covering of stained tissue for instance by overlaying eloquent brain tissue.…”

Section: Discussionmentioning

confidence: 99%

The use of the sodium fluorescein and YELLOW 560 nm filter for the resection of pediatric posterior fossa lesions

et al. 2022

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Purpose This study aimed to verify the feasibility, safety, and benefit of using fluorescein sodium (FL) and a YELLOW 560 nm filter in posterior fossa tumors in children. Methods All cases of pediatric posterior fossa tumors that have undergone surgery using fluorescein (2018–2022) have been included and were examined retrospectively. In those cases where resection of the tumor was planned, a blinded neuroradiologist distinguished gross total resection and subtotal resection according to the postoperative MRI findings. The surgical report and medical files were reviewed regarding the intraoperative staining grade and adverse events. The grade of fluorescent staining of the targeted lesion was assessed as described in the surgical reports. The screening was conducted for any reference to the degree of fluorescent staining: “intense,” “medium,” “slight,” and “no staining.” Results 19 cases have been included. In 14 cases, a complete resection was initially intended. In 11 of these cases, a gross total resection could be achieved (78.6%). Staining was described as intense in most cases (58.8%). Except for yellow-colored urine, no side effects obviously related to FL were found throughout the observation period. Conclusion In combination with a specific filter, FL is a reliable, safe, and feasible tool in posterior fossa surgery in children.

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Paediatric posterior fossa tumour resection rates in a small volume centre: the past decade’s experience

Cited by 5 publications

References 32 publications

Fluorescein-guided surgery for the resection of pilocytic astrocytomas: A multicentric retrospective study

Fluorescein-guided surgery for the resection of pilocytic astrocytomas: A multicentric retrospective study

Long-term outcome after management of pilocytic astrocytoma in the posterior fossa in a pediatric population

The use of the sodium fluorescein and YELLOW 560 nm filter for the resection of pediatric posterior fossa lesions

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