Grin Katherina, Azizi Amedeo, Haberler Christine, Peyrl Andreas, Kasprian Gregor, Czech Thomas, Rössler Karl, Gojo Johannes, Dorfer Christian
Department of Neurosurgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria.
Childs Nerv Syst. 2024 Dec 28;41(1):73. doi: 10.1007/s00381-024-06733-w.
We aimed to present our surgical experience and the impact of a solid or cystic morphology of cerebellar pilocytic astrocytoma (cPA) on surgery and the risk for a re-resection.
We retrospectively analyzed all children operated at our institution between 2009 and 2023 for cPA. Tumours were categorized into 4 groups: (i) cystic PA without cyst wall enhancement, (ii) cystic PA with cyst wall enhancement, (iii) solid tumour, (iv) and solid tumour with central necrosis.
Forty-two children with a median age at surgery of 7.1 years (range 0.7-14 years; male to female ratio 1.5) were identified. The median follow-up time was 3.1 years (0.6-14 years). Twenty-eight patients (66.6%) presented with cystic PA (20 without and 8 with cyst wall enhancement), 9 patients (21.4%) exhibited a solid tumour with central necrosis and 5 (11.9%) had a solid tumour without central necrosis. Gross total resection could be achieved in 31 patients (73.8%), near total resection in 6 (14.3%), and subtotal resection in 5 (11.9%). Progression occurred in 11 cases with 9 patients having a 2nd resection after a mean time of 3.4 years. The highest risk for a 2nd resection was seen in the group of solid tumours with a necrotic centre (odds ratio = 2.3), progression of enhancing cyst wall remnants was seen in one out of two patients with remnants needing reoperation.
Surgery in cerebellar PA should aim for gross total resection of the solid-enhancing tumour.
我们旨在介绍我们的手术经验以及小脑毛细胞型星形细胞瘤（cPA）的实性或囊性形态对手术及再次切除风险的影响。
我们回顾性分析了2009年至2023年间在我们机构接受cPA手术的所有儿童。肿瘤被分为4组：（i）无囊壁强化的囊性PA，（ii）有囊壁强化的囊性PA，（iii）实性肿瘤，（iv）有中央坏死的实性肿瘤。
确定了42例手术时中位年龄为7.1岁（范围0.7 - 14岁；男女比例1.5）的儿童。中位随访时间为3.1年（0.6 - 14年）。28例患者（66.6%）表现为囊性PA（20例无囊壁强化，8例有囊壁强化），9例患者（21.4%）表现为有中央坏死的实性肿瘤，5例（11.9%）有无中央坏死的实性肿瘤。31例患者（73.8%）可实现全切除，6例（14.3%）接近全切除，5例（11.9%）次全切除。11例出现进展，9例患者在平均3.4年后进行了二次切除。在有坏死中心的实性肿瘤组中二次切除风险最高（优势比 = 2.3），在两名需要再次手术的有强化囊壁残余的患者中，有一例出现强化囊壁残余进展。
小脑PA的手术应旨在全切除实性强化肿瘤。
