Sutton L N, Cnaan A, Klatt L, Zhao H, Zimmerman R, Needle M, Molloy P, Phillips P
Department of Neurosurgery, Children's Hospital of Philadelphia, Pennsylvania, USA.
J Neurosurg. 1996 May;84(5):721-5. doi: 10.3171/jns.1996.84.5.0721.
The standard follow-up care for children with cerebellar astrocytomas includes regular surveillance imaging of the brain with computerized tomography or magnetic resonance. The purpose of surveillance imaging is to detect asymptomatic tumor recurrence at an early stage and permit safer reoperation. The authors evaluated the effectiveness of an intensive surveillance program for cerebellar astrocytoma and tested different models of surveillance frequency and duration to arrive at a specific recommended program. Review of the records of 93 children with typical cerebellar astrocytomas who received follow-up care between 1975 and 1993 was performed. Immediate postoperative and surveillance images were classified as showing definite equivocal, or no tumor based on the radiology report at the time the image was obtained. Various surveillance models were then tested for their predictive value for detecting tumor recurrence. Seventeen (18%) of the 93 children had tumor recurrence or progression. Eleven of these tumors were asymptomatic and detected only by surveillance image. Tumor recurred in only one patient with a total resection, whereas tumor progression occurred in five of 21 patients with equivocal postoperative images and in 11 of 14 patients with residual tumor. A model in which patients with possible or definite residual tumor after surgery undergo surveillance at 12, 18, 30, 42, and 66 months, and later have one additional image, yielded optimum predictive value for recurrence and/or progression with the fewest images. Patients with tumor recurrence were satisfactorily treated, and only one patient died. Children with totally resected cerebellar astrocytomas do not appear to benefit from routine surveillance, because the likelihood of recurrence is small. Surveillance is of benefit in those who may have subtotal resection based on the immediate postoperative imaging.
小脑星形细胞瘤患儿的标准后续护理包括定期使用计算机断层扫描或磁共振成像对脑部进行监测成像。监测成像的目的是在早期检测出无症状的肿瘤复发，并允许进行更安全的再次手术。作者评估了一项针对小脑星形细胞瘤的强化监测计划的有效性，并测试了不同的监测频率和时长模型，以得出具体的推荐方案。对1975年至1993年间接受后续护理的93例典型小脑星形细胞瘤患儿的记录进行了回顾。根据获取图像时的放射学报告，将术后即刻和监测图像分类为显示明确、可疑或无肿瘤。然后测试各种监测模型对检测肿瘤复发的预测价值。93例患儿中有17例（18%）出现肿瘤复发或进展。其中11例肿瘤无症状，仅通过监测图像检测到。仅1例全切患儿出现肿瘤复发，而术后图像可疑的21例患儿中有5例出现肿瘤进展，14例有残留肿瘤的患儿中有11例出现肿瘤进展。一种模型是，术后可能或明确有残留肿瘤的患者在12、18、30、42和66个月时接受监测，之后再进行一次成像，该模型在复发和/或进展的预测价值最佳，且成像数量最少。肿瘤复发的患者得到了满意的治疗，仅1例死亡。小脑星形细胞瘤全切的患儿似乎未从常规监测中获益，因为复发的可能性较小。对于根据术后即刻成像可能行次全切除的患儿，监测是有益的。
