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Article ; Online: Response.

Khan, Ursalan A / Kamaly-Asl, Ian D

2016 Volume 124, Issue 3, Page(s) 888–890

MeSH term(s)	Brain Neoplasms/mortality ; Brain Neoplasms/surgery ; Female ; Glioma/mortality ; Glioma/surgery ; Humans ; Male ; Medical Oncology ; Neurosurgery ; Specialization
Language	English
Publishing date	2016-03
Publishing country	United States
Document type	Comment ; Letter
ZDB-ID	3089-2
ISSN	1933-0693 ; 0022-3085
ISSN (online)	1933-0693
ISSN	0022-3085
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Article ; Online: Operative planning aid for optimal endoscopic third ventriculostomy entry points in pediatric cases.

Zador, Zsolt / Coope, David J / Mostofi, Abteen / Kamaly-Asl, Ian D

Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery

2017 Volume 33, Issue 2, Page(s) 269–273

Abstract: Object: Endoscopic third ventriculostomy (ETV) uses anatomical spaces of the ventricular system to reach the third ventricle floor and create an alternative pathway for cerebrospinal fluid flow. Optimal ETV trajectories have been previously proposed in ... ...

Abstract	Object: Endoscopic third ventriculostomy (ETV) uses anatomical spaces of the ventricular system to reach the third ventricle floor and create an alternative pathway for cerebrospinal fluid flow. Optimal ETV trajectories have been previously proposed in the literature, designed to grant access to the third ventricle floor without a displacement of eloquent periventricular structures. However, in hydrocephalus, there is a significant variability to the configuration of the ventricular system, implying that the optimal ETV trajectory and cranial entry point needs to be planned on a case-by-case basis. In the current study, we created a mathematical model, which tailors the optimal ETV entry point to the individual case by incorporating the ventricle dimensions. Methods: We retrospectively reviewed the imaging of 30 consecutive pediatric patients with varying degrees of ventriculomegaly. Three dimensional radioanatomical models were created using preoperative MRI scans to simulate the optimal ETV trajectory and entry point for each case. The surface location of cranial entry points for individual ETV trajectories was recorded as Cartesian coordinates centered at Bregma. The distance from the Bregma in the coronal plane represented as "x", and the distance from the coronal suture in the sagittal plane represented as "y". The correlation between the ventricle dimensions and the x, y coordinates were tested using linear regression models. Results: The distance of the optimal ETV entry point from the Bregma in the coronal plane ("x") and from the coronal suture in the sagittal plane ("y") correlated well with the frontal horn ratio (FHR). The coordinates for x and y were fitted along the following linear equations: x = 85.8 FHR-13.3 (r Conclusion: The surface location of the optimal cranial ETV entry point correlates well with the ventricle size. We provide the first model that can be used as a surgical planning aid for a case specific ETV entry site with the incorporation of the ventricle size.
MeSH term(s)	Adolescent ; Child ; Child, Preschool ; Female ; Humans ; Hydrocephalus/diagnostic imaging ; Hydrocephalus/surgery ; Image Processing, Computer-Assisted ; Infant ; Linear Models ; Magnetic Resonance Imaging ; Male ; Neuroendoscopy/methods ; Retrospective Studies ; Third Ventricle/surgery ; Treatment Outcome ; Ventriculostomy/methods
Language	English
Publishing date	2017-02
Publishing country	Germany
Document type	Journal Article
ZDB-ID	605988-0
ISSN	1433-0350 ; 0302-2803 ; 0256-7040
ISSN (online)	1433-0350
ISSN	0302-2803 ; 0256-7040
DOI	10.1007/s00381-016-3320-y
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Article ; Online: Comparative analysis of endoscopic third ventriculostomy trajectories in pediatric cases.

Zador, Zsolt / Coope, David J / Kamaly-Asl, Ian D

Journal of neurosurgery. Pediatrics

2015 Volume 16, Issue 6, Page(s) 626–632

Abstract: Object: Endoscopic third ventriculostomy (ETV) has become a widely used method for CSF diversion when treating obstructive hydrocephalus. There are multiple recommendations on the transcortical ETV entry points, and some are specifically designed to ... ...

Abstract	Object: Endoscopic third ventriculostomy (ETV) has become a widely used method for CSF diversion when treating obstructive hydrocephalus. There are multiple recommendations on the transcortical ETV entry points, and some are specifically designed to provide a trajectory that avoids displacement to the eloquent periventricular structures. However, the morphology of the ventricular system is highly variable in hydrocephalus, and therefore a single best ETV trajectory may not be applicable to all cases. In the current study, 3 frequently quoted ETV entry points are compared in a cohort of pediatric cases with different degrees of ventriculomegaly. Methods: The images of 30 consecutive pediatric patients with varying degrees of ventriculomegaly were reviewed. Three-dimensional models were created using radiological analysis of anatomical detail and preoperative MRI scans in order to simulate 3 frequently quoted ETV trajectories for rigid neuroendoscopes. These trajectories were characterized based on the frequency and depth of tissue displacement to structures such as the fornix, caudate nucleus, genu of the internal capsule, and thalamus. The results are stratified based on ventricle size using the frontal horn ratio (FHR). Results: Eloquent areas were displaced in nearly all analyzed entry points (97%-100%). Stratifying the data based on ventricle size revealed that (1) lateral structures were more likely to be displaced in cases of intermediate ventriculomegaly (FHR < 0.4) using all 3 trajectories, whereas (2) the fornix was less likely to be displaced using more posteriorly placed trajectories for severe ventriculomegaly (FHR > 0.4). Allowing for minimal (2.4 mm) tissue displacement, a more posterior entry point was less traumatic for severe ventriculomegaly. Conclusions: There is no single best ETV trajectory that fully avoids displacement of the eloquent periventricular structures. Larger ventricles require a more posteriorly placed entry point in order to reduce injury to the eloquent structures, and intermediate ventricles would dictate a medial entry point. These results suggest that the optimal entry point should be selected on a case-by-case basis after incorporating ventricle size.
MeSH term(s)	Adolescent ; Child ; Child, Preschool ; Female ; Humans ; Hydrocephalus/diagnosis ; Hydrocephalus/surgery ; Infant ; Infant, Newborn ; Magnetic Resonance Imaging ; Male ; Neuroendoscopy/methods ; Severity of Illness Index ; Third Ventricle/pathology ; Third Ventricle/surgery ; Treatment Outcome ; Ventriculostomy/methods
Language	English
Publishing date	2015-12
Publishing country	United States
Document type	Comparative Study ; Journal Article
ZDB-ID	2403985-8
ISSN	1933-0715 ; 1933-0707
ISSN (online)	1933-0715
ISSN	1933-0707
DOI	10.3171/2015.4.PEDS14430
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Article ; Online: Nonsynostotic Posterior Brachycephaly with Hindbrain Herniation.

Pathmanaban, Omar N / Burke, Kerry A / Leach, Paul / Thorne, John / Kamaly-Asl, Ian D

World neurosurgery

2017 Volume 97, Page(s) 755.e11–755.e15

Abstract: Background: Positional plagiocephaly is the most common cause of cranial asymmetry. The underlying cause of Chiari-1 malformation has many possible theories, and anecdotally some pediatric neurosurgeons have had experience of severe cases of positional ... ...

Abstract	Background: Positional plagiocephaly is the most common cause of cranial asymmetry. The underlying cause of Chiari-1 malformation has many possible theories, and anecdotally some pediatric neurosurgeons have had experience of severe cases of positional brachycephaly with Chiari-1. However, to date, there have been no published cases linking nonsynostotic plagiocephaly with Chiari-1 malformation. Case description: An 18-month-old boy presented with a head injury. On examination he had a Glasgow Coma Score of 15 with no focal neurologic deficits, but he was noted to have marked posterior brachycephaly. A computed tomography scan showed a slim left-sided hemispheric acute subdural hematoma with no mass effect, which was treated conservatively. Of note, all of his cranial vault sutures were open, and a diagnosis of incidental positional plagiocephaly was made. Subsequent magnetic resonance imaging as part of a work-up to exclude nonaccidental injury showed a small posterior fossa with a steep tentorium and herniation of the cerebellar tonsils to the level of the body of the second cervical vertebra. Conclusions: Chronic hindbrain herniation is well reported in cases of craniosynostosis, but to our knowledge this is the first published case associated with nonsynostotic deformational plagiocephaly. We hypothesize that severe posterior plagiocephaly can cause disproportion of the posterior fossa: hindbrain volume ratio and acquired chronic cerebellar herniation. Nevertheless, positional plagiocephaly and Chiari-1 are common entities, and it is possible that the dual diagnoses were coincidental in this case. This report serves to raise awareness of a putative causal relationship between positional plagiocephaly, reduced posterior fossa volume, and hindbrain herniation.
MeSH term(s)	Child, Preschool ; Craniosynostoses/complications ; Craniosynostoses/diagnostic imaging ; Craniosynostoses/surgery ; Encephalocele/complications ; Encephalocele/diagnostic imaging ; Encephalocele/surgery ; Humans ; Infant ; Male ; Plagiocephaly, Nonsynostotic/complications ; Plagiocephaly, Nonsynostotic/diagnostic imaging ; Plagiocephaly, Nonsynostotic/surgery ; Rhombencephalon/diagnostic imaging ; Rhombencephalon/surgery
Language	English
Publishing date	2017-01
Publishing country	United States
Document type	Case Reports ; Journal Article
ZDB-ID	2534351-8
ISSN	1878-8769 ; 1878-8750
ISSN (online)	1878-8769
ISSN	1878-8750
DOI	10.1016/j.wneu.2016.10.027
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Article ; Online: Use of intraoperative Doppler ultrasound with neuronavigation to guide arteriovenous malformation resection: a pediatric case series.

Walkden, James S / Zador, Zsolt / Herwadkar, Amit / Kamaly-Asl, Ian D

Journal of neurosurgery. Pediatrics

2015 Volume 15, Issue 3, Page(s) 291–300

Abstract: Object: Over the last 20 years, several intraoperative adjuncts, including ultrasonography, neuronavigation, and angiography, have been said to aid the intraoperative localization and resection of cerebral arteriovenous malformations (AVMs). The authors ...

Abstract	Object: Over the last 20 years, several intraoperative adjuncts, including ultrasonography, neuronavigation, and angiography, have been said to aid the intraoperative localization and resection of cerebral arteriovenous malformations (AVMs). The authors assessed the value of intraoperative Doppler ultrasonography in conjunction with neuronavigation during surgery for cerebral AVMs in the pediatric population. Methods: The authors reviewed all cranial AVM resections performed by a single surgeon at their institution in the period from 2007 to 2013 and here describe their experience and results in a series of 20 consecutive AVM resections in 19 pediatric patients. Intraoperative Doppler ultrasonography had been used in conjunction with preoperative CT or neuronavigational MRI. Preoperative and postoperative clinical findings, patient age, and Spetzler-Martin AVM grade were identified in all patients. Results: All patients, whose ages ranged from 2 to 16 years, underwent craniotomy and excision of an AVM, which was supratentorial in 18 cases and infratentorial in 2. Patients in 11 cases underwent preoperative embolization, and all other patients underwent cerebral angiography prior to surgery, except for 2 patients who were urgently surgically treated because of low Glasgow Coma Scale scores and associated hematoma. Spetzler-Martin Grades I (3 cases), II (6), III (7), and IV (4) AVMs were represented in this series. Intraoperative Doppler ultrasound provided high-quality images in all cases and demonstrated the location, size, and flow characteristics of the AVM and any associated hematoma. Delayed postoperative cerebral angiography demonstrated successful AVM resection in all cases. An assessment of clinical outcomes revealed no new long-term neurological deficits at 3 months postoperatively. Conclusions: Intraoperative Doppler ultrasonography is a reliable and useful tool for intraoperative localization and guidance for AVM resection in the pediatric population. When used in conjunction with neuronavigation equipment and modern microscopes, this technique has shown a very high complete resection rate with extremely low associated morbidity.
MeSH term(s)	Adolescent ; Cerebral Angiography ; Child ; Child, Preschool ; Embolization, Therapeutic ; Female ; Humans ; Infant ; Intracranial Arteriovenous Malformations/diagnostic imaging ; Intracranial Arteriovenous Malformations/surgery ; Intracranial Arteriovenous Malformations/therapy ; Male ; Microscopy ; Monitoring, Intraoperative/methods ; Neuronavigation/methods ; Neurosurgical Procedures/methods ; Ultrasonography, Doppler, Color ; Vascular Surgical Procedures/methods
Language	English
Publishing date	2015-03
Publishing country	United States
Document type	Case Reports ; Journal Article
ZDB-ID	2403985-8
ISSN	1933-0715 ; 1933-0707
ISSN (online)	1933-0715
ISSN	1933-0707
DOI	10.3171/2014.10.PEDS14249
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Article ; Online: Ventriculoperitoneal shunt survival in children who require additional abdominal surgery--are our estimations of the additional risk accurate?

Li Ching, Angela / Humphrey, Gill / Kamaly-Asl, Ian D

British journal of neurosurgery

2014 Volume 28, Issue 1, Page(s) 40–48

Abstract: Objective: Ventriculoperitoneal shunt (VPS)-dependent children require abdominal surgery for many reasons. Our objective was to quantify the risk of abdominal surgery on VPS survival and to determine whether timing of abdominal intervention impacts on ... ...

Abstract	Objective: Ventriculoperitoneal shunt (VPS)-dependent children require abdominal surgery for many reasons. Our objective was to quantify the risk of abdominal surgery on VPS survival and to determine whether timing of abdominal intervention impacts on shunt outcome. Methods: Retrospective data collection was performed on all children undergoing primary VPS insertion or revision over 2 years (1/1/08-31/12/10). All shunt interventions were categorised into two groups: those undergoing additional "Abdominal surgery" (AS) versus those undergoing "Shunt-only" (SO). Kaplan-Meier survival curves were devised and analysed using log-rank. In the AS group, we compared shunt survival for shunts inserted at various "Time from abdominal surgery" (TAS). We conducted a control analysis to compare shunt survival in AS, SO and a control "clean general surgery" (SG) group. Chi-squared test was used to determine the cause of shunt failure in these three groups. Results: Three hundred and forty two shunts from 109 patients were included. Twenty patients contributed 118 shunts to the AS group. Median shunt survival was 3.68 months (95% CI = 1.01-6.47) and 22.6 months (95% CI = 8.76-36.4) in the AS and SO groups, respectively (log-rank = 16.6, p < 0.001). For each additional abdominal intervention, the risk of shunt failure increased by 55.4% (p < 0.001). Median shunt survival was 1.48 months (95% CI = 0.00-3.09, p < 0.001), if shunt insertion occurred within 1 year of abdominal surgery. Beyond 1 year, median shunt survival increased five-fold to 7.65 months (95% CI = 0.00-20.1, log-rank = 23.2, p < 0.001). There was a 29% reduction in risk of shunt failure per year interval between a shunt and an abdominal surgery (95% CI = 0.11-0.44, p < 0.005). Our control analysis confirmed that shunts in the AS group had worst survival and infection (p < 0.001). Conclusion: Additional abdominal surgery shortens VPS lifetime and increases risk of infection. Delaying abdominal surgery from a shunt intervention or vice versa by at least 1 year may prolong shunt survival.
MeSH term(s)	Abdomen/surgery ; Adolescent ; Child ; Child, Preschool ; Digestive System Surgical Procedures/statistics & numerical data ; Equipment Failure ; Female ; Humans ; Infant ; Kaplan-Meier Estimate ; Male ; Reoperation ; Retrospective Studies ; Risk Assessment ; Time Factors ; Treatment Outcome ; Ventriculoperitoneal Shunt/adverse effects ; Ventriculoperitoneal Shunt/classification
Language	English
Publishing date	2014-01
Publishing country	England
Document type	Comparative Study ; Journal Article
ZDB-ID	639029-8
ISSN	1360-046X ; 0268-8697
ISSN (online)	1360-046X
ISSN	0268-8697
DOI	10.3109/02688697.2013.815322
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Article ; Online: Non-myeloablative busulfan chimeric mouse models are less pro-inflammatory than head-shielded irradiation for studying immune cell interactions in brain tumours.

Youshani, A Saam / Rowlston, Samuel / O'Leary, Claire / Forte, Gabriella / Parker, Helen / Liao, Aiyin / Telfer, Brian / Williams, Kaye / Kamaly-Asl, Ian D / Bigger, Brian W

Journal of neuroinflammation

2019 Volume 16, Issue 1, Page(s) 25

Abstract: Background: Chimeric mouse models generated via adoptive bone marrow transfer are the foundation for immune cell tracking in neuroinflammation. Chimeras that exhibit low chimerism levels, blood-brain barrier disruption and pro-inflammatory effects prior ...

Abstract	Background: Chimeric mouse models generated via adoptive bone marrow transfer are the foundation for immune cell tracking in neuroinflammation. Chimeras that exhibit low chimerism levels, blood-brain barrier disruption and pro-inflammatory effects prior to the progression of the pathological phenotype, make it difficult to distinguish the role of immune cells in neuroinflammatory conditions. Head-shielded irradiation overcomes many of the issues described and replaces the recipient bone marrow system with donor haematopoietic cells expressing a reporter gene or different pan-leukocyte antigen, whilst leaving the blood-brain barrier intact. However, our previous work with full body irradiation suggests that this may generate a pro-inflammatory peripheral environment which could impact on the brain's immune microenvironment. Our aim was to compare non-myeloablative busulfan conditioning against head-shielded irradiation bone marrow chimeras prior to implantation of glioblastoma, a malignant brain tumour with a pro-inflammatory phenotype. Methods: Recipient wild-type/CD45.1 mice received non-myeloablative busulfan conditioning (25 mg/kg), full intensity head-shielded irradiation, full intensity busulfan conditioning (125 mg/kg) prior to transplant with whole bone marrow from CD45.2 donors and were compared against untransplanted controls. Half the mice from each group were orthotopically implanted with syngeneic GL-261 glioblastoma cells. We assessed peripheral blood, bone marrow and spleen chimerism, multi-organ pro-inflammatory cytokine profiles at 12 weeks and brain chimerism and immune cell infiltration by whole brain flow cytometry before and after implantation of glioblastoma at 12 and 14 weeks respectively. Results: Both non-myeloablative conditioning and head-shielded irradiation achieve equivalent blood and spleen chimerism of approximately 80%, although bone marrow engraftment is higher in the head-shielded irradiation group and highest in the fully conditioned group. Head-shielded irradiation stimulated pro-inflammatory cytokines in the blood and spleen but not in the brain, suggesting a systemic response to irradiation, whilst non-myeloablative conditioning showed no cytokine elevation. Non-myeloablative conditioning achieved higher donor chimerism in the brain after glioblastoma implantation than head-shielded irradiation with an altered immune cell profile. Conclusion: Our data suggest that non-myeloablative conditioning generates a more homeostatic peripheral inflammatory environment than head-shielded irradiation to allow a more consistent evaluation of immune cells in glioblastoma and can be used to investigate the roles of peripheral immune cells and bone marrow-derived subsets in other neurological diseases.
MeSH term(s)	Animals ; Antineoplastic Agents, Alkylating/pharmacology ; Bone Marrow Cells/drug effects ; Bone Marrow Cells/immunology ; Bone Marrow Cells/radiation effects ; Brain Neoplasms/immunology ; Busulfan/pharmacology ; Cell Line, Tumor ; Chimera ; Cytokines/blood ; Female ; Glioblastoma/pathology ; Immunity, Cellular/drug effects ; Immunity, Cellular/radiation effects ; Inflammation/chemically induced ; Inflammation/pathology ; Leukocyte Common Antigens/genetics ; Mice ; Mice, Inbred C57BL ; Neoplasm Transplantation ; Radiation Chimera
Chemical Substances	Antineoplastic Agents, Alkylating ; Cytokines ; Leukocyte Common Antigens (EC 3.1.3.48) ; Busulfan (G1LN9045DK)
Language	English
Publishing date	2019-02-05
Publishing country	England
Document type	Journal Article
ISSN	1742-2094
ISSN (online)	1742-2094
DOI	10.1186/s12974-019-1410-y
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Article ; Online: Ventricular metastatic dissemination of a paediatric craniopharyngioma: case report and literature review.

Carleton-Bland, Nick / Kilday, John-Paul / Pathmanaban, Omar N / Stivaros, Stavros / Kelsey, Anna / Kamaly-Asl, Ian D

British journal of neurosurgery

2016 Volume 31, Issue 4, Page(s) 474–477

Abstract: Distant intraventricular metastasis is extremely rare in childhood craniopharyngioma. Here, we report the isolated posterior ventricular recurrence of an adamantinomatous craniopharyngioma, in a child previously treated with surgery and proton beam ... ...

Abstract	Distant intraventricular metastasis is extremely rare in childhood craniopharyngioma. Here, we report the isolated posterior ventricular recurrence of an adamantinomatous craniopharyngioma, in a child previously treated with surgery and proton beam therapy for local progression. The importance of surveillance imaging is highlighted, while specific surgical approaches and techniques are considered.
MeSH term(s)	Brain Neoplasms/secondary ; Brain Neoplasms/surgery ; Child, Preschool ; Craniopharyngioma/surgery ; Humans ; Male ; Neoplasm Recurrence, Local/surgery ; Neuronavigation/methods ; Pituitary Neoplasms/surgery ; Proton Therapy/methods
Language	English
Publishing date	2016-06-16
Publishing country	England
Document type	Case Reports ; Journal Article ; Review
ZDB-ID	639029-8
ISSN	1360-046X ; 0268-8697
ISSN (online)	1360-046X
ISSN	0268-8697
DOI	10.3109/02688697.2016.1139050
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Article ; Online: Telemetric intra-cranial pressure monitoring: clinical and financial considerations.

Barber, James M / Pringle, Catherine J / Raffalli-Ebezant, Helen / Pathmanaban, Omar / Ramirez, Roberto / Kamaly-Asl, Ian D

British journal of neurosurgery

2016 Volume 31, Issue 3, Page(s) 300–306

Abstract: Intracranial pressure (ICP) measurement is an important diagnostic tool in Neurosurgery. Until relatively recently, conventional monitoring has required that subjects be admitted to a hospital bed and the device is only able to be left in-situ for ... ...

Abstract	Intracranial pressure (ICP) measurement is an important diagnostic tool in Neurosurgery. Until relatively recently, conventional monitoring has required that subjects be admitted to a hospital bed and the device is only able to be left in-situ for limited periods of time. We have evaluated a Telemetric ICP monitoring system that has been proven, by several other groups worldwide, to permit rapid, repeated and prolonged ICP measurement, in multiple environments. In our unit, 4 patients have been implanted to-date, between the ages of 4 and 16, manifesting a wide range of complex neurosurgical conditions. The sensors have been left in-situ for between 460 and 632 days. There have been no clinical complications and the system has been universally well tolerated. Clinical events, costs and patient experience were all assessed prior to and following implantation. Overall, there was a significant reduction in associated admissions (44.3%), imaging requirements (72.5%) and costs (50.0%). Subjective feedback from both the patients (where possible) and their families was overwhelmingly positive, partly due to (a) the system's ease of use, (b) its ability to reduce the number of admissions/tests required and (c) the facility for rapid measurement of ICP that permitted on-the-spot reassurance of concerns. Additionally, the ability to monitor ICP at home and/or whilst ambulant, has provided measurements that were hitherto inaccessible to our team, facilitating all the potential benefits that analysis of such information would provide. Indeed, we have seen the resultant management in each case has been completely altered by the availability of this data, reaffirming that the importance of being able to obtain it should not be underestimated. The combination of both this and the ability to markedly improve patient experience, along with generating significant cost-savings, lead the authors to suggest that the implantation of this system should be strongly considered in selected individuals.
MeSH term(s)	Adolescent ; Child ; Child, Preschool ; Cost Savings ; Equipment Design ; Female ; Hospitalization/economics ; Humans ; Intracranial Pressure/physiology ; Male ; Neurosurgery/economics ; Neurosurgery/methods ; Neurosurgical Procedures/economics ; Neurosurgical Procedures/methods ; Retrospective Studies ; Telemetry/economics ; Telemetry/instrumentation ; Telemetry/methods ; Time Factors
Language	English
Publishing date	2016-09-19
Publishing country	England
Document type	Case Reports ; Evaluation Studies ; Journal Article
ZDB-ID	639029-8
ISSN	1360-046X ; 0268-8697
ISSN (online)	1360-046X
ISSN	0268-8697
DOI	10.1080/02688697.2016.1229752
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Article ; Online: Outcomes with respect to extent of surgical resection for pediatric atypical teratoid rhabdoid tumors.

Richards, Alexandra / Ved, Ronak / Murphy, Christopher / Hennigan, Dawn / Kilday, John-Paul / Kamaly-Asl, Ian / Mallucci, Conor / Bhatti, Imran / Patel, Chirag / Leach, Paul

Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery

2019 Volume 36, Issue 4, Page(s) 713–719

Abstract: Purpose: To evaluate overall survival for atypical teratoid rhabdoid tumors (ATRTs) in relation to extent of surgical resection.: Methods: The neurosurgical tumor databases from three UK Pediatric centers (University Hospital of Wales, Alder Hey and ... ...

Abstract	Purpose: To evaluate overall survival for atypical teratoid rhabdoid tumors (ATRTs) in relation to extent of surgical resection. Methods: The neurosurgical tumor databases from three UK Pediatric centers (University Hospital of Wales, Alder Hey and Royal Manchester Children's Hospital) were analyzed. Patients with a diagnosis of ATRT were identified between 2000 and 2018. Data was collected regarding demographics, extent of resection, complications, and overall survival. Results: Twenty-four patients diagnosed with ATRT underwent thirty-eight operations. The age range was 20 days to 147 months (median 17.5 months). The most common location for the tumor was the posterior fossa (nine patients; 38%). Six patients (25%) underwent a complete total resection (CTR), seven (29%) underwent a near total resection (NTR), eight (33.3%) underwent a subtotal resection (STR), and three patients (12.5%) had biopsy only. Two-thirds of patients who underwent a CTR are still alive, as of March 2019, compared to 29% in the NTR and 12.5% in the STR groups. Out of the thirty-eight operations, there were a total of twenty-two complications, of which the most common was pseudomeningocele (27%). The extent of surgical resection (p = 0.021), age at surgery (p = 0.00015), and the presence of metastases at diagnosis (0.015) significantly affected overall survival. Conclusions: Although these patients are a highly vulnerable group, maximal resection is recommended where possible, for the best chance of long-term survival. However, near total resections are likely beneficial when compared with subtotal resections and biopsy alone. Maximal surgical resection should be combined with adjuvant therapies for the best long-term outcomes.
MeSH term(s)	Central Nervous System Neoplasms ; Child ; Combined Modality Therapy ; Humans ; Infant ; Retrospective Studies ; Rhabdoid Tumor/surgery
Language	English
Publishing date	2019-12-31
Publishing country	Germany
Document type	Journal Article
ZDB-ID	605988-0
ISSN	1433-0350 ; 0302-2803 ; 0256-7040
ISSN (online)	1433-0350
ISSN	0302-2803 ; 0256-7040
DOI	10.1007/s00381-019-04478-5
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