title: Clinical significance and limitations of repeat resection for pediatric malignant neuroepithelial tumors: clinical article.
abstract: OBJECTIVE
  Maximized tumor resection and minimized surgical morbidity are extremely important in the treatment of children with malignant neuroepithelial tumors. However, the indications for repeat surgery for these tumors remain unclear. The present study investigated the clinical significance and limitations of repeat resection for these tumors.
  
  
  METHODS
  This study included 61 consecutive pediatric patients with malignant neuroepithelial tumor, histologically diagnosed as WHO Grades III and IV. All patients were initially treated between January 1997 and March 2011 and had follow-up of more than 2 years. The number of surgeries, presence of leptomeningeal dissemination, survival, WHO grade, and Eastern Cooperative Oncology Group performance status before and after surgery were retrospectively reviewed.
  
  
  RESULTS
  Repeat resections were performed for 21 patients (34.4%). Eastern Cooperative Oncology Group performance status was not aggravated by surgery, even after multiple operations. The 5-year survival rates of patients who received single and repeat surgery were 58.6% and 38.7%, respectively (p = 0.12). The mean interval between initial surgery and leptomeningeal dissemination detection was 331 ± 108 days in the single-surgery group and 549 ± 122 days in the repeat-surgery group (p = 0.19). The median survival time after leptomeningeal dissemination was 580 days in the single-surgery group and 890 days in the repeat-surgery group (p = 0.74).
  
  
  CONCLUSIONS
  Repeat resection with minimized surgical morbidity is an effective method to achieve better local control of pediatric malignant neuroepithelial tumors. Leptomeningeal dissemination was a leading cause of death, but repeat surgery did not increase the frequency of death.
authors.affiliation: Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan.
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Kawaguchi
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Kumabe
authors.forename: Ryuta
authors.initials: R
authors.lastname: Saito
authors.forename: Masayuki
authors.initials: M
authors.lastname: Kanamori
authors.forename: Yoji
authors.initials: Y
authors.lastname: Yamashita
authors.forename: Yukihiko
authors.initials: Y
authors.lastname: Sonoda
authors.forename: Teiji
authors.initials: T
authors.lastname: Tominaga
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007223:Infant; D053208:Kaplan-Meier Estimate; D008279:Magnetic Resonance Imaging; D008297:Male; D060787:Neoplasm Grading; D018302:Neoplasms, Neuroepithelial / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D019635:Neurosurgical Procedures; D012086:Reoperation; D012189:Retrospective Studies