Kozyrev Danil A, Constantini Shlomi, Tsering Deki, Keating Robert, Basal Sharif, Roth Jonathan
Department of Pediatric Neurosurgery, Dana Children's Hospital, Tel Aviv Medical Center, Tel Aviv University, 6 Weizmann Street, 64239, Tel Aviv, Israel.
Children's National Medical Center, Washington, DC, USA.
Childs Nerv Syst. 2020 Mar;36(3):601-609. doi: 10.1007/s00381-019-04364-0. Epub 2019 Sep 6.
Pediatric brain incidentalomas are increasingly being diagnosed. As the posterior fossa (PF) is the location of most brain tumors in children, lesions of this region are of special interest. Currently, the natural history of incidental lesions in the PF is unknown. We present our experience treating such lesions.
A retrospective study was carried out in two large tertiary pediatric centers. Patients were included if they had an incidental PF lesion suspected of being a tumor, and diagnosed before the age of 20 years. We analyzed treatment strategy, pathology, and outcome of operated and non-operated cases.
Seventy children (31 females) with a mean age of 8.4 ± 6.1 years were included. The three most common indications for imaging were headaches (16, assumed to be unrelated to the lesions), workup of unrelated conditions (14), and unspecified reasons (14). Twenty-seven patients (39%) were operated immediately, and 43 followed, of which 12 were eventually operated due to radiological changes, 28.9 ± 16.2 months after diagnosis. The most commonly found pathology was pilocytic astrocytomas (21 of 39 operated cases). Almost 10% were found to be malignant tumors including medulloblastomas (5) and ATRT (1).
Incidental PF lesions in children include both benign and malignant tumors. While certain lesions may be followed, others may require surgical treatment. Specific treatment decisions are based on initial radiological appearance, change in radiological characteristics over time, location, and evolving symptoms. The surgical risks must be balanced vis-à-vis the risk of missing a high-grade tumor and the very rare risk of malignant transformation.
小儿脑偶发瘤的诊断越来越多。由于后颅窝（PF）是儿童大多数脑肿瘤的发生部位，该区域的病变特别令人关注。目前，PF区偶发病变的自然史尚不清楚。我们介绍我们治疗此类病变的经验。
在两家大型三级儿科中心进行了一项回顾性研究。纳入的患者为怀疑患有肿瘤的PF区偶发病变且在20岁之前确诊者。我们分析了手术和非手术病例的治疗策略、病理及结果。
纳入70名儿童（31名女性），平均年龄8.4±6.1岁。影像学检查的三个最常见指征是头痛（16例，认为与病变无关）、检查无关疾病（14例）和未明确原因（14例）。27例患者（39%）立即接受了手术，43例进行了随访，其中12例因影像学改变最终接受了手术，诊断后28.9±16.2个月。最常见的病理类型是毛细胞型星形细胞瘤（39例手术病例中的21例）。近10%被发现为恶性肿瘤，包括髓母细胞瘤（5例）和非典型畸胎样/横纹肌样肿瘤（ATRT，1例）。
儿童PF区偶发病变包括良性和恶性肿瘤。虽然某些病变可以进行观察，但其他病变可能需要手术治疗。具体的治疗决策基于初始影像学表现、影像学特征随时间的变化、位置及症状演变。必须权衡手术风险与漏诊高级别肿瘤的风险以及恶性转化的极低风险。
