The role of surgery in multidisciplinary treatment of pediatric brain tumors

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  • 小児脳腫瘍の集学的治療における外科的治療の意義(<総会特集>脳腫瘍に対する集学的治療)

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Abstract

Surgical treatment plays a central role in the management of most brain tumors except pontine glioma and germinoma. Treatment is often multidisciplinary and has become increasingly complex. Questions remain with regard to the surgical treatment of pediatric brain tumors. For example, what is the best operative approach for the fourth ventricle ependymoma that is invasive of the brain stem? Complete resection of ependymomas that invade the fourth ventricle floor are much more difficult and achieved with higher complication rates. Although total removal is the single most important prognostic factor, it was achieved in only 60% of patients in past studies. Medulloblastoma of the fourth ventricle usually involve the vermis, but can involve the brain stem. GTR of the tumor is the goal of surgery. However, a small amount of residual tumor (<1.5cm^2) invading the brain stem do not appear to influence overall outcome. Cerebellar mutism is a unique surgical complication that is characterized by mutism, abulia, high pitched cry, and oral motor apraxia. The indications of surgery in chiasmatic/hypothalamic astrocytomas are still evolving. The risks of aggressive resection are significant and there is increasing evidence that chemotherapy is an effective treatment for these tumors. The goals of surgical treatment include biopsy, subtotal resection, and decompression of surrounding neural structures with minimal morbidity. There is overwhelming evidence that cytoreductive surgery is beneficial to children with both benign and malignant gliomas. PNET and ATRT are very malignant tumors resistant to chemo- and radiotherapy. The role of GTR is less clear in these tumors.

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