Pollack I F
Department of Neurosurgery, Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pennsylvania 15213, USA.
J Neurooncol. 1999 May;42(3):271-88. doi: 10.1023/a:1006107227856.
Pediatric glial tumors differ from adult gliomas in several ways that are of major therapeutic importance. First, the value of extensive tumor resection, which is controversial for malignant intrinsic brain tumors in adults, has been confirmed for a variety of childhood brain tumors, such as supratentorial high-grade and low-grade gliomas and infratentorial low-grade gliomas, ependymomas, and some medulloblastomas. Second, chemotherapy has been found to be effective in improving overall outcome in several childhood brain tumors, such as medulloblastoma and supratentorial high-grade glioma, but has yet to be proven to have a major benefit for adult tumors. In addition, chemotherapy is increasingly used to delay or avoid radiotherapy in young children with high-grade and incompletely resected low-grade tumors to avoid the morbidity of irradiation on the developing nervous system. Third, the prognosis for histologically similar tumors is often more favorable in children than adults. The present chapter will highlight the unique features of childhood glial tumors, discuss general principles in the clinical presentation, diagnostic evaluation, and treatment of these tumors, and then focus on the surgical management and outcome of the more common types of tumors.
小儿胶质肿瘤在几个具有重要治疗意义的方面与成人胶质瘤不同。首先，广泛肿瘤切除对于成人恶性原发性脑肿瘤存在争议，但其对多种儿童脑肿瘤，如幕上高级别和低级别胶质瘤、幕下低级别胶质瘤、室管膜瘤以及一些髓母细胞瘤而言，其价值已得到证实。其次，已发现化疗对改善几种儿童脑肿瘤的总体预后有效，如髓母细胞瘤和幕上高级别胶质瘤，但尚未证明其对成人肿瘤有重大益处。此外，对于高级别和未完全切除的低级别肿瘤的幼儿，化疗越来越多地用于延迟或避免放疗，以避免放疗对发育中的神经系统造成的损害。第三，组织学相似的肿瘤，儿童的预后通常比成人更有利。本章将重点介绍儿童胶质肿瘤的独特特征，讨论这些肿瘤在临床表现、诊断评估和治疗方面的一般原则，然后着重探讨较常见类型肿瘤的手术管理及结果。
