Yecies Derek, Azad Tej D, Esparza Rogelio, Quon Jennifer L, Forkert Nils D, MacEachern Sarah J, Bruckert Lisa, Maleki Maryam, Edwards Michael S B, Grant Gerald A, Yeom Kristen W
Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA.
Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA.
World Neurosurg. 2019 Feb;122:e1300-e1304. doi: 10.1016/j.wneu.2018.11.039. Epub 2018 Nov 16.
Current standard of care for children with infratentorial ependymoma includes maximal safe resection and local radiation of 54-59 Gray. High-dose local radiation has been associated with declines in multiple cognitive domains. The anatomic and physiologic correlates of this cognitive decline remain undefined, and there have been no radiographic studies on the long-term effects of this treatment paradigm.
A comprehensive database of pediatric brain tumor patients treated at Stanford Children's from 2004-2016 was queried. Seven patients with posterior fossa ependymoma who were treated with surgery and local radiation alone, who had no evidence of recurrent disease, and had imaging suitable for analysis were identified. Diffusion-weighted magnetic resonance imaging datasets were used to calculate apparent diffusion coefficient maps for each subject, while arterial spin labeling datasets were used to calculate maps of cerebral blood flow. Diffusion-weighted imaging and arterial spin labeling datasets of 52 age-matched healthy children were analyzed in the same fashion to enable group comparisons.
Several statistically significant differences were detected between the 2 groups. Cerebral blood flow was lower in the caudate and pallidum and higher in the nucleus accumbens in the ependymoma cohort compared with controls. Apparent diffusion coefficient was increased in the thalamus and trended toward decreased in the amygdala.
Surgery and local radiation for posterior fossa ependymoma are associated with supratentorial apparent diffusion coefficient and cerebral blood flow alterations, which may represent an anatomic and physiologic correlate to the previously published decline in neurocognitive outcomes in this population.
目前，幕下室管膜瘤患儿的标准治疗方案包括最大限度的安全切除以及54 - 59格雷的局部放疗。高剂量局部放疗与多个认知领域的功能下降有关。这种认知下降的解剖学和生理学相关性仍不明确，且尚无关于这种治疗模式长期影响的影像学研究。
查询了2004年至2016年在斯坦福儿童医院接受治疗的小儿脑肿瘤患者的综合数据库。确定了7例仅接受手术和局部放疗、无疾病复发证据且有适合分析的影像学资料的后颅窝室管膜瘤患者。使用扩散加权磁共振成像数据集计算每个受试者的表观扩散系数图，同时使用动脉自旋标记数据集计算脑血流量图。以同样的方式分析了52名年龄匹配的健康儿童的扩散加权成像和动脉自旋标记数据集，以便进行组间比较。
两组之间检测到了几个具有统计学意义的差异。与对照组相比，室管膜瘤队列中尾状核和苍白球的脑血流量较低，伏隔核的脑血流量较高。丘脑的表观扩散系数增加，杏仁核的表观扩散系数有下降趋势。
后颅窝室管膜瘤的手术和局部放疗与幕上表观扩散系数和脑血流量改变有关，这可能是此前报道的该人群神经认知结果下降的解剖学和生理学相关因素。
