Department of Neurosurgery, Rutgers-Robert Wood Johnson Medical School University Hospital, New Brunswick, New Jersey, USA.
Robert Wood Johnson Medical School-Rutgers, New Brunswick, New Jersey, USA.
World Neurosurg. 2020 Jul;139:121-131. doi: 10.1016/j.wneu.2020.02.178. Epub 2020 Mar 9.
Management of incidental asymptomatic brain tumors in children is controversial due to lack of clear evidence-based guidelines. We present this systematic review in an attempt to highlight an optimal treatment paradigm.
This systematic review was conducted in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Databases were searched up to August 2019 using the keywords "incidental," "brain tumor," and "pediatric." Our main focus was on brain lesions suspected for neoplasm, diagnosed incidentally on neuroimaging in an otherwise asymptomatic patient <18 years old. Cystic, vascular, and inflammatory brain lesions were excluded.
Fourteen studies comprising 308 patients were included. All cases were diagnosed using magnetic resonance imaging. The most common indications for imaging were headache (93; 30%) and trauma (72; 23%). Lesion distribution was supratentorial (179; 58%), infratentorial (121; 40%), and intraventricular (8; 3%). Of 308 cases, 243 (79%) were managed with neuroradiological surveillance and 57 (19%) by upfront surgical excision. Of those managed conservatively, 177 (73%) remained stable within a mean follow-up of 30 months, 54 (22%) progressed, and 12 (5%) spontaneously regressed. Meanwhile, upfront excision achieved complete remission in all 57 cases over a mean follow-up of 68.3 months.
A small body of evidence has emerged, highlighting the marked heterogeneity and contradictory results between the available studies, limiting our ability to draw solid conclusions. At this point, the decision between surgery and "watchful waiting" should be tailored on an individual patient basis depending on suspicion of malignancy, clinical or radiologic progression, and parental preference.
由于缺乏明确的循证医学指南，儿童无症状偶然脑肿瘤的治疗存在争议。我们进行这项系统评价，旨在强调最佳的治疗模式。
本系统评价按照系统评价和荟萃分析的首选报告项目进行。使用“偶然”、“脑肿瘤”和“儿科”等关键词，于 2019 年 8 月前在数据库中进行搜索。我们的主要重点是怀疑为肿瘤的脑部病变，在无其他症状的 18 岁以下患者的神经影像学检查中偶然发现。囊性、血管性和炎性脑部病变被排除在外。
纳入了 14 项研究，共 308 例患者。所有病例均通过磁共振成像诊断。最常见的影像学检查指征为头痛（93 例，30%）和外伤（72 例，23%）。病变分布为幕上（179 例，58%）、幕下（121 例，40%）和脑室（8 例，3%）。308 例患者中，243 例（79%）采用神经影像学监测治疗，57 例（19%）采用直接手术切除。接受保守治疗的患者中，177 例（73%）在平均 30 个月的随访中保持稳定，54 例（22%）进展，12 例（5%）自发消退。同时，57 例直接切除的患者在平均 68.3 个月的随访中均完全缓解。
现有研究数量较少，结果存在显著的异质性和矛盾性，限制了我们得出确凿结论的能力。目前，手术与“观察等待”之间的决策应根据恶性肿瘤的可疑程度、临床或影像学进展以及家长的偏好，个体化制定。
