Chapter 26 Infratentorial Tumors

2015 ◽  
pp. 170-181
Keyword(s):  
Infratentorial Tumors

scholarly journals Pediatric and Adult Low-Grade Gliomas: Where Do the Differences Lie?

Children ◽  
2021 ◽  
Vol 8 (11) ◽  
pp. 1075
Author(s):  
Ladina Greuter ◽  
Raphael Guzman ◽  
Jehuda Soleman
Keyword(s):  
Primary Treatment ◽  
The Other ◽  
Awake Surgery ◽  
Low Grade ◽  
Total Excision ◽  
Cerebrospinal Fluid Flow ◽  
Pilocytic Astrocytomas ◽  
The Brain ◽  
Initial Results ◽  
Infratentorial Tumors

Two thirds of pediatric gliomas are classified as low-grade (LGG), while in adults only around 20% of gliomas are low-grade. However, these tumors do not only differ in their incidence but also in their location, behavior and, subsequently, treatment. Pediatric LGG constitute 65% of pilocytic astrocytomas, while in adults the most commonly found histology is diffuse low-grade glioma (WHO II), which mostly occurs in eloquent regions of the brain, while its pediatric counterpart is frequently found in the infratentorial compartment. The different tumor locations require different skillsets from neurosurgeons. In adult LGG, a common practice is awake surgery, which is rarely performed on children. On the other hand, pediatric neurosurgeons are more commonly confronted with infratentorial tumors causing hydrocephalus, which more often require endoscopic or shunt procedures to restore the cerebrospinal fluid flow. In adult and pediatric LGG surgery, gross total excision is the primary treatment strategy. Only tumor recurrences or progression warrant adjuvant therapy with either chemo- or radiotherapy. In pediatric LGG, MEK inhibitors have shown promising initial results in treating recurrent LGG and several ongoing trials are investigating their role and safety. Moreover, predisposition syndromes, such as neurofibromatosis or tuberous sclerosis complex, can increase the risk of developing LGG in children, while in adults, usually no tumor growth in these syndromes is observed. In this review, we discuss and compare the differences between pediatric and adult LGG, emphasizing that pediatric LGG should not be approached and managed in the same way as adult LCG.

scholarly journals Incidence of intraoperative seizures during motor evoked potential monitoring in a large cohort of patients undergoing different surgical procedures

2017 ◽  
Vol 126 (4) ◽  
pp. 1296-1302 ◽  
Author(s):  
Sedat Ulkatan ◽  
Ana Maria Jaramillo ◽  
Maria J. Téllez ◽  
Jinu Kim ◽  
Vedran Deletis ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Interventional Radiology ◽  
Brain Stimulation ◽  
Peripheral Nerves ◽  
Wide Spectrum ◽  
Vascular Lesions ◽  
Transcranial Electrical Stimulation ◽  
Electrical Brain Stimulation ◽  
Interventional Radiology Procedures ◽  
Infratentorial Tumors

OBJECTIVE The purpose of this study was to investigate the incidence of seizures during the intraoperative monitoring of motor evoked potentials (MEPs) elicited by electrical brain stimulation in a wide spectrum of surgeries such as those of the orthopedic spine, spinal cord, and peripheral nerves, interventional radiology procedures, and craniotomies for supra- and infratentorial tumors and vascular lesions. METHODS The authors retrospectively analyzed data from 4179 consecutive patients who underwent surgery or an interventional radiology procedure with MEP monitoring. RESULTS Of 4179 patients, only 32 (0.8%) had 1 or more intraoperative seizures. The incidence of seizures in cranial procedures, including craniotomies and interventional neuroradiology, was 1.8%. In craniotomies in which transcranial electrical stimulation (TES) was applied to elicit MEPs, the incidence of seizures was 0.7% (6/850). When direct cortical stimulation was additionally applied, the incidence of seizures increased to 5.4% (23/422). Patients undergoing craniotomies for the excision of extraaxial brain tumors, particularly meningiomas (15 patients), exhibited the highest risk of developing an intraoperative seizure (16 patients). The incidence of seizures in orthopedic spine surgeries was 0.2% (3/1664). None of the patients who underwent surgery for conditions of the spinal cord, neck, or peripheral nerves or who underwent cranial or noncranial interventional radiology procedures had intraoperative seizures elicited by TES during MEP monitoring. CONCLUSIONS In this largest such study to date, the authors report the incidence of intraoperative seizures in patients who underwent MEP monitoring during a wide spectrum of surgeries such as those of the orthopedic spine, spinal cord, and peripheral nerves, interventional radiology procedures, and craniotomies for supra- and infratentorial tumors and vascular lesions. The low incidence of seizures induced by electrical brain stimulation, particularly short-train TES, demonstrates that MEP monitoring is a safe technique that should not be avoided due to the risk of inducing seizures.

THE SEIZURE AS A MANIFESTATION OF INTRACRANIAL TUMOR IN CHILDHOOD

PEDIATRICS ◽  
1962 ◽  
Vol 29 (6) ◽  
pp. 978-984
Author(s):  
Reno E. Backus ◽  
J. Gordon Millichap
Keyword(s):  
Cerebral Cortex ◽  
Age At Onset ◽  
Intracranial Tumor ◽  
Total Group ◽  
Sharp Wave ◽  
Initial Symptoms ◽  
Tumor In Childhood ◽  
Supratentorial Tumors ◽  
Infratentorial Tumors

The records of 291 children treated over a 10-year period for intracranial tumor were examined, with particular attention to patients with seizures. Seizures occurred in 17% of the total group—in 25% of patients with supratentorial tumors and in 12% of those with infratentorial tumors. They were the initial symptoms in 15% of patients with supratentorial tumors and in 1% of those with infratentorial tumors. The average age at onset was 4.9 years in the supratentorial group and 4.8 years in the infratentorial group. The diagnosis of supratentorial tumors was delayed for an average of 2 years, whereas infratentorial tumors were diagnosed within an average time of 3 months of the initial seizure. Eight patients continued to have seizures for periods between 3 and 8 years before a tumor was suspected. The pattern of the initial seizure was of localizing value in 75% of patients with supratentorial tumors that involved the cerebral cortex and in 16% of patients with infratentorial tumors. In patients with seizures the electroencephalogram was of localizing value in 92% of tumors that involved the cerebral cortex, and abnormalities maximal in the occipital areas were compatible with the localization of 44% of infratentorial tumors. Spike, sharp wave, or spike and wave seizure discharges were present in 32% of patients with supratentorial tumors.

scholarly journals Neurological evaluation of children and adolescents with brain tumor, based on ambulatory-oriented follow-up

2001 ◽  
Vol 59 (4) ◽  
pp. 849-853 ◽  
Author(s):  
Alexandre Serafim ◽  
Luiz Celso Pereira Vilanova ◽  
Najla Saba Silva
Keyword(s):  
Brain Tumor ◽  
Brain Tumors ◽  
Children And Adolescents ◽  
Tumor Recurrence ◽  
Clinical Perspective ◽  
Tumor Patients ◽  
Female Patients ◽  
Neurological Evaluation ◽  
Infratentorial Tumors

Taken as proved that brain tumors are the second most frequent childhood neoplasm - only outnumbered by leukemias - we have undertaken a clinical perspective study with seventy brain tumor patients ranging from one to fifteen years of age, throughout a four-year period (1993-1997), based on ambulatory-oriented follow-up. Forty-one male and twenty-nine female patients were analyzed, in that a slightly higher number of infratentorial tumors was observed (thirty-eight cases), compared to those supratentorially located (thirty-two cases). The most repeatedly observed during the study was the medulloblastoma (twenty-one patients), followed by the astrocytoma (fifteen patients) and the germinoma (eleven patients). It should be pointed out that during the ambulatory follow-up 75,5% of patients developed neurological sequels. A tumor recurrence was noticed in 34,3% of them, while 21,4% eventually died.

scholarly journals Ewing Sarcoma of the Posterior Fossa in an Adolescent Girl

2014 ◽  
Vol 2014 ◽  
pp. 1-4 ◽  
Author(s):  
Andreas M. Stark ◽  
Ivo Leuschner ◽  
H. Maximilian Mehdorn ◽  
Alexander Claviez
Keyword(s):  
Ewing Sarcoma ◽  
Adolescent Girl ◽  
Multimodal Treatment ◽  
Tumor Resection ◽  
Treatment Protocol ◽  
Intracranial Tumors ◽  
Increased Intracranial Pressure ◽  
Important Differential Diagnosis ◽  
Infratentorial Tumors ◽  
Space Occupying Lesion

Medulloblastoma, astrocytoma, and ependymoma represent the most common infratentorial tumors in childhood, while Ewing sarcomas in that localization are extremely rare. A large left infratentorial space-occupying lesion was diagnosed in a 12-year-old girl with signs of increased intracranial pressure. Following total tumor resection, histological and molecular examination revealed Ewing sarcoma with rearrangedEWSR-1gene. The patient achieved complete remission following adjuvant chemotherapy and radiotherapy according to Euro-EWING 2008 treatment protocol. Intracranial Ewing sarcoma, although rare, should be an important differential diagnosis of intracranial tumors in childhood which requires aggressive multimodal treatment.

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