McAuley Ellen, Brophy Hannah, Hayden James, Pettorini Benedetta, Parks Chris, Avula Shivaram, Mallucci Conor, Pizer Barry
Department of Paediatric Oncology, Alder Hey Children's Hospital, Eaton Road, Liverpool, L12 2AP, UK.
Department of Paediatric Neurosurgery, Alder Hey Children's Hospital, Eaton Road, Liverpool, L12 2AP, UK.
Childs Nerv Syst. 2019 May;35(5):801-805. doi: 10.1007/s00381-019-04078-3. Epub 2019 Feb 15.
Paediatric cerebellar pilocytic astrocytomas (PA) (WHO grade 1) are amongst the most common of childhood brain tumours and are generally amenable to resection, with surgery alone being curative in the majority of cases. There is, however, a lack of consensus regarding the frequency and duration of post-treatment MRI surveillance for these tumours. This is important, as follow-up imaging is a significant use of resources and often associated with patient and family anxiety. We have assessed the utility of MRI surveillance in the detection of cerebellar PA recurrence at our regional paediatric neurosurgical centre.
The tumour register at Alder Hey Children's Hospital was searched to identify all patients diagnosed between 2007 and 2017, with a confirmed histopathological diagnosis of cerebellar PA. Patient demographics, surgical outcome, number of MRI scans and length of follow-up were recorded for each patient.
Forty patients met the inclusion criteria. The mean age at diagnosis was 7.8 years (range 2 to 17 years). Complete surgical resection (CR), confirmed by post-operative MRI, was achieved in 36 of the 40 patients, including all 31 cases from 2009 and later for which intraoperative MRI (iMRI) was utilised. There was one case of recurrence after CR (at 2.2 years) out of the 36 cases, whereas all 4 patients with initial partial resections had progressive growth of their tumours and required second surgical interventions.
This series confirms the very low likelihood of recurrence for completely resected cerebellar PAs and suggests that in such cases the duration and frequency of surveillance imaging could be limited to a maximum of 2.5 to 3 years of follow-up imaging. This report also indicates improved complete resection rates over time, probably associated with technical advances including the routine in-house use of iMRI in 2009.
小儿小脑毛细胞型星形细胞瘤（PA）（世界卫生组织1级）是儿童期最常见的脑肿瘤之一，通常适合手术切除，大多数情况下仅手术即可治愈。然而，对于这些肿瘤治疗后MRI监测的频率和持续时间，目前尚无共识。这一点很重要，因为后续成像会大量消耗资源，且常常会引起患者及其家属的焦虑。我们在我们地区的儿科神经外科中心评估了MRI监测在检测小脑PA复发方面的效用。
检索奥尔德希儿童医院的肿瘤登记册，以确定2007年至2017年间所有经组织病理学确诊为小脑PA的患者。记录每位患者的人口统计学资料、手术结果、MRI扫描次数和随访时间。
40例患者符合纳入标准。诊断时的平均年龄为7.8岁（范围2至17岁）。40例患者中有36例通过术后MRI证实实现了完全手术切除（CR），包括2009年及以后的所有31例病例，这些病例术中使用了术中MRI（iMRI）。36例CR病例中有1例复发（2.2年时），而最初部分切除的所有4例患者肿瘤均进展生长，需要二次手术干预。
本系列研究证实完全切除的小脑PA复发可能性极低，并表明在这种情况下，监测成像的持续时间和频率可限制在最多2.5至3年的随访成像。本报告还表明，随着时间的推移，完全切除率有所提高，这可能与技术进步有关，包括2009年开始在内部常规使用iMRI。
