title: Greater extent of resection improves ganglioglioma recurrence-free survival in children: a volumetric analysis.
abstract: BACKGROUND
  Gangliogliomas are rare, low-grade, glial-neural tumors that are most often found in children. They can recur with varying frequency; yet few data are available that adequately predict such events.
  
  
  OBJECTIVE
  To review our institution's large series of gangliogliomas in children and identify clinical features that predict recurrence-free survival.
  
  
  METHODS
  Clinical records were retrospectively reviewed from 1990 to 2011. Fifty-three children were identified, and pertinent clinical features were analyzed against survival data to categorize lesions at high risk of recurrence.
  
  
  RESULTS
  Fifteen children (28%) experienced a recurrence during the study period with a median time to recurrence of 8.8 months and a mean follow-up of 4.2 years. The 5-year recurrence-free survival rate was 70.5%, whereas the overall survival rate was 98.1%. Older age at diagnosis (P = .02), seizure history (P < .001), supratentorial tumor location (P < .001), and greater extent of surgical resection (P < .001) were all associated with improved recurrence-free survival on univariate analysis. Extent of surgical resection was the only clinical variable that retained its significance in multivariate models (P = .01). Patients who received 94% or greater volumetric extent of resection had prolonged recurrence-free survival compared with those individuals who received a less than 94% resection (P = .02).
  
  
  CONCLUSIONS
  Attention to specific clinical variables, most notably the extent of surgical resection, can further stratify grade I gangliogliomas into low- and high-risk groups among children. Although 100% resection should remain an operative goal for surgically accessible gangliogliomas, a thorough yet subtotal resection may improve recurrence-free survival.
authors.affiliation: Departments of *Neurological Surgery and ‡Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri.
authors.forename: Devon H
authors.initials: DH
authors.lastname: Haydon
authors.forename: Sonika
authors.initials: S
authors.lastname: Dahiya
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Smyth
authors.forename: David D
authors.initials: DD
authors.lastname: Limbrick
authors.forename: Jeffrey R
authors.initials: JR
authors.lastname: Leonard
mesh_terms: D000293:Adolescent; D001932:Brain Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D005260:Female; D018303:Ganglioglioma / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D006801:Humans; D007223:Infant; D053208:Kaplan-Meier Estimate; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology* / Q000401:mortality; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D015996:Survival Rate; D055815:Young Adult