Clinical impact of integrating positron emission tomography during surgery in 85 children with brain tumors.
OBJECTIVE
In this paper, the authors' goal was to evaluate the impact of PET information on brain tumor surgery in children.


METHODS
Between 1995 and 2007, 442 children were referred to the authors' institution for a newly diagnosed brain lesion. Of these, 85 were studied with FDG-PET and/or L-(methyl-(11)C)-methionine -PET in cases in which MR images were unable to assist in selecting accurate biopsy targets (35 patients) or to delineate tumors for maximal resection (50 patients). In surgical cases, PET and MR images were combined in image fusion planning for stereotactic biopsies or navigation-based resections. The preoperative planning images were compared postoperatively with MR imaging and PET findings and histological data for evaluating the clinical impact on the diagnostic yield and tumor resection.


RESULTS
The PET data influenced surgical decisions or procedures in all cases. The use of PET helped to better differentiate indolent from active components in complex lesions (in 12 patients); improved target selection and diagnostic yield of stereotactic biopsies without increasing the sampling; provided additional prognostic information; reduced the amount of tissue needed for biopsy sampling in brainstem lesions (in 20 cases); better delineated lesions that were poorly delineated on MR imaging and that infiltrated functional cortex (in 50 cases); significantly increased the amount of tumor tissue removed in cases in which total resection influenced survival (in 20 cases); guided resection in hypermetabolic areas (in 15 cases); improved early postoperative detection of residual tumor (in 20 cases); avoided unnecessary reoperation (in 5 cases); and supported the decision to undertake early second-look resection (in 8 cases).


CONCLUSIONS
The authors found that PET has a significant impact on the surgical decisions and procedures for managing pediatric brain tumors. Further studies may demonstrate whether PET improves outcomes in children.
Pirotte
Benoit J M
BJ
Department of Neurosurgery, Hôpital Erasme, Université Libre de Bruxelles, 808, route de Lennik, B-1070 Brussels, Belgium. bpirotte@ulb.ac.be
Lubansu
Alphonse
A
Massager
Nicolas
N
Wikler
David
D
Van Bogaert
Patrick
P
Levivier
Marc
M
Brotchi
Jacques
J
Goldman
Serge
S
D000293:Adolescent; D001530:Belgium; D001932:Brain Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery*; D002250:Carbon Radioisotopes; D002648:Child; D002675:Child, Preschool; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D007091:Image Processing, Computer-Assisted; D033162:Incidental Findings; D007223:Infant; D008279:Magnetic Resonance Imaging; D008297:Male; D008715:Methionine / Q000031:analogs & derivatives; D038361:Neuronavigation; D049268:Positron-Emission Tomography; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000601:surgery; D012086:Reoperation; D012189:Retrospective Studies; D012680:Sensitivity and Specificity
D002250:Carbon Radioisotopes; D019788:Fluorodeoxyglucose F18; D008715:Methionine; C038344:methionine methyl ester