Steinbok Paul, Mangat Jaspreet Singh, Kerr John M, Sargent Michael, Suryaningtyas Wihasto, Singhal Ashutosh, Cochrane Doug
Division of Pediatric Neurosurgery, Department of Surgery, BC Children's Hospital and University of British Columbia, 4480 Oak St, #K3-159, V6H 3V4, Vancouver, BC, Canada.
Childs Nerv Syst. 2013 Aug;29(8):1269-75. doi: 10.1007/s00381-013-2171-z. Epub 2013 May 29.
Review of children with low-grade cerebellar astrocytoma (LGCA) prior to 1992 showed a 98% rate of gross total resection (GTR) but a concerning incidence of permanent neurological dysfunction. The purpose of this study was to determine the rate of GTR of LGCA since 1992 and frequency of neurologic injury.
Retrospective review of children with LGCA was performed. CT/MR scans were rereviewed to assess extent of resection. Primary outcomes included incidence of GTR and incidence of permanent new neurological deficits. Other outcomes included late effects severity score (LESS), Bloom score for functional status, and educational assessment.
Of 50 LGCA, GTR was achieved in 38 (76%) compared to 43 of 44 (98%) prior to 1992 (p < 0.004). Permanent new neurologic deficits from surgery occurred in 16% compared to 18% in the prior era (p = 0.61). For 35 patients operated on by the 2 surgeons in the prior study, 74% had GTR, with permanent neurological deficits in 8.6%. At latest follow-up, all patients were alive, 16% with residual tumor. LESS was two or less (mild or no deficit) in 94%. Bloom score was one or two (no or mild disability) in 90%. Eighty-six percent attended normal school.
Less aggressive resection of LGCA in children may reduce postoperative neurologic deficits in the hands of the same surgeons as in the prior study but not overall at our institution. The good long-term outcomes suggest that it may be appropriate to do incomplete resection rather than risk additional neurological deficit.
对1992年以前的低级别小脑星形细胞瘤（LGCA）患儿的回顾显示，大体全切（GTR）率为98%，但永久性神经功能障碍的发生率令人担忧。本研究的目的是确定1992年以来LGCA的GTR率和神经损伤频率。
对LGCA患儿进行回顾性研究。重新审查CT/MR扫描以评估切除范围。主要结局包括GTR的发生率和永久性新神经功能缺损的发生率。其他结局包括迟发效应严重程度评分（LESS）、功能状态的布鲁姆评分和教育评估。
50例LGCA患儿中，38例（76%）实现了GTR，而1992年以前44例中的43例（98%）实现了GTR（p<0.004）。手术导致的永久性新神经功能缺损发生率为16%，而之前的发生率为18%（p=0.61）。对于之前研究中由两位外科医生手术的35例患者，74%实现了GTR，永久性神经功能缺损发生率为8.6%。在最近一次随访时，所有患者均存活，16%有残留肿瘤。94%的患者LESS评分为2分或更低（轻度或无缺损）。90%的患者布鲁姆评分为1分或2分（无残疾或轻度残疾）。86%的患者就读于普通学校。
与之前的研究相比，在同一外科医生手中，对儿童LGCA进行不太积极的切除可能会减少术后神经功能缺损，但在我们机构总体上不会。良好的长期结局表明，进行不完全切除而非冒额外神经功能缺损的风险可能是合适的。
