The role of screening spinal MRI in children with solitary posterior fossa low-grade glial tumors

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OBJECTIVE

Solitary posterior fossa low-grade glial tumors (SPFLGT) in children are rarely associated with leptomeningeal dissemination (LMD). To date, there are no clear guidelines regarding the role of screening and surveillance spinal MRI (sMRI) in children with SPFLGT, at diagnosis or during follow-up periods. The current study reviews a cohort of children with SPFLGT, focusing on sMRI findings.

METHODS

In this binational retrospective study, the authors analyzed 229 patients with SPFLGT treated and followed over 13 years. One hundred twelve children had at least 1 total sMRI screening or surveillance examination. One hundred seventeen had no sMRI, but did not present with clinical spinal signs or symptoms. Collected data included demographics, disease characteristics, radiology, pathology, and clinical follow-up data.

RESULTS

For the 112 children with at least 1 sMRI, the mean duration from diagnosis to first sMRI was 11.73 ± 28.66 months (range 0–165 months). All sMRI scans were conducted as screening examinations, with no spinal-related symptoms. One patient was found to have a sacral intradural lesion concurrent to the brain tumor diagnosis. Over the course of 180 radiological and 533 clinical follow-up years for the 112 patients with sMRI, and 582 clinical follow-up years for the 117 patients with no sMRI, there were no additional cases with spinal tumor spread.

CONCLUSIONS

The yield of screening sMRI in the absence of cranial metastasis, or spinal symptoms, is extremely low. Because preoperative sMRI is recommended for medulloblastomas and ependymomas, it may be logical to acquire. During the follow-up period the authors recommend limiting sMRI in patients without symptoms suggesting a spinal lesion, in patients without known cranial metastases, or recurrence or residual SPFLGT.

ABBREVIATIONS EOR = extent of resection; LGG = low-grade glioma; LMD = leptomeningeal dissemination; PA = pilocytic astrocytoma; sMRI = spinal MRI; SPFLGT = solitary posterior fossa low-grade glial tumor.
Article Information

Contributor Notes

Correspondence Jonathan Roth: Dana Children’s Hospital, Tel-Aviv Medical Center, Tel-Aviv, Israel. jonaroth@gmail.com.INCLUDE WHEN CITING Published online November 15, 2019; DOI: 10.3171/2019.9.PEDS19358.

J.R. and N.F. contributed equally to this work.

Disclosures Dr. Limbrick reports support of non–study-related clinical or research effort from Medtronic, Inc., and Microbot Medical, Inc.
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References
  • 1

    Bian SXMcAleer MFVats TSMahajan AGrosshans DR: Pilocytic astrocytoma with leptomeningeal dissemination. Childs Nerv Syst 29:4414502013

    • Search Google Scholar
    • Export Citation
  • 2

    Buschmann UGers BHildebrandt G: Pilocytic astrocytomas with leptomeningeal dissemination: biological behavior, clinical course, and therapeutical options. Childs Nerv Syst 19:2983042003

    • Search Google Scholar
    • Export Citation
  • 3

    Civitello LAPacker RJRorke LBSiegel KSutton LNSchut L: Leptomeningeal dissemination of low-grade gliomas in childhood. Neurology 38:5625661988

    • Search Google Scholar
    • Export Citation
  • 4

    Crabtree KLArnold PM: Spinal seeding of a pilocytic astrocytoma in an adult, initially diagnosed 18 years previously. Pediatr Neurosurg 46:66702010

    • Search Google Scholar
    • Export Citation
  • 5

    Demirkaya MSevinir BGüler SDemiröz CTaskapilioglu ÖYilmazlar S: Leptomeningeal dissemination and vertebral bone involvement in a child with pilocytic astrocytoma. Pediatr Int (Roma) 58:134113442016

    • Search Google Scholar
    • Export Citation
  • 6

    Drobysheva AKlesse LJBowers DCRajaram VRakheja DTimmons CF: Targeted MAPK pathway inhibitors in patients with disseminated pilocytic astrocytomas. J Natl Compr Canc Netw 15:9789822017

    • Search Google Scholar
    • Export Citation
  • 7

    Figueiredo EGMatushita HMachado AGGPlese JPPRosemberg SMarino R Jr: Leptomeningeal dissemination of pilocytic astrocytoma at diagnosis in childhood: two cases report. Arq Neuropsiquiatr 61:8428472003

    • Search Google Scholar
    • Export Citation
  • 8

    Gajjar ASanford RAHeideman RJenkins JJWalter ALi Y: Low-grade astrocytoma: a decade of experience at St. Jude Children’s Research Hospital. J Clin Oncol 15:279227991997

    • Search Google Scholar
    • Export Citation
  • 9

    Hukin JSiffert JVelasquez LZagzag DAllen J: Leptomeningeal dissemination in children with progressive low-grade neuroepithelial tumors. Neuro Oncol 4:2532602002

    • Search Google Scholar
    • Export Citation
  • 10

    Jamjoom ABJamjoom ZAal-Rayess M: Intraventricular and leptomeningeal dissemination of a pilocytic cerebellar astrocytoma in a child with a ventriculoperitoneal shunt: case report. Br J Neurosurg 12:56581998

    • Search Google Scholar
    • Export Citation
  • 11

    Kanda MTanaka HShinoda SMasuzawa T: Leptomeningeal dissemination of pilocytic astrocytoma via hematoma in a child. Case report. Neurosurg Focus 13(1):ECP22002

    • Search Google Scholar
    • Export Citation
  • 12

    Mahore AKammar ADange NEpari SGoel A: Diencephalic juvenile pilomyxoid astrocytoma with leptomeningeal dissemination. Turk Neurosurg 21:2222252011

    • Search Google Scholar
    • Export Citation
  • 13

    Mazloom AHodges JCTeh BSChintagumpala MPaulino AC: Outcome of patients with pilocytic astrocytoma and leptomeningeal dissemination. Int J Radiat Oncol Biol Phys 84:3503542012

    • Search Google Scholar
    • Export Citation
  • 14

    Ostrom QTGittleman HFulop JLiu MBlanda RKromer C: CBTRUS statistical report: primary brain and central nervous system tumors diagnosed in the United States in 2008-2012. Neuro Oncol 17 (Suppl 4):iv1iv622015

    • Search Google Scholar
    • Export Citation
  • 15

    Tamura MZama AKurihara HFujimaki HImai HKano T: Management of recurrent pilocytic astrocytoma with leptomeningeal dissemination in childhood. Childs Nerv Syst 14:6176221998

    • Search Google Scholar
    • Export Citation
  • 16

    Tien RDTuori SLPulkingham NBurger PC: Ganglioglioma with leptomeningeal and subarachnoid spread: results of CT, MR, and PET imaging. AJR Am J Roentgenol 159:3913931992

    • Search Google Scholar
    • Export Citation
  • 17

    Warmuth-Metz MKühl JKrauss JSolymosi L: Subdural enhancement on postoperative spinal MRI after resection of posterior cranial fossa tumours. Neuroradiology 46:2192232004

    • Search Google Scholar
    • Export Citation
  • 18

    Zorlu FSelek UAkyuz COzturk ASoylemezoglu FAkalan N: Spinal seeding of a pilocytic astrocytoma following multiple subtotal resections. Pediatr Neurosurg 41:2482522005

    • Search Google Scholar
    • Export Citation
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