title: Neurosurgical treatment of pediatric low-grade midbrain tumors: a single consecutive institutional series of 15 patients.
abstract: OBJECTIVE
  The authors delineate the long-term results of surgical treatment for pediatric low-grade midbrain glioma.
  
  
  METHODS
  A series of 15 consecutive patients (age range 0-15 years) who underwent primary tumor resection for a low-grade midbrain glioma during the years 1989-2010 were included in this retrospective study on surgical morbidity, mortality rate, academic achievement, and/or work participation. Gross motor function and activities of daily living were scored according to the Barthel Index.
  
  
  RESULTS
  Of the 15 patients, 10 were in their 1st decade (age 0-9 years) and 5 were in their 2nd decade of life (age 10-15 years) at the time of surgery. The male/female ratio was 0.50 (5:10). No patients were lost to follow-up. One patient died in the postoperative period (32 days posttreatment). Another 2 patients died during follow-up. One patient succumbed to acute bleeding in the resection cavity 8 months after surgery, and the other died of shunt failure 21 years after initial treatment. Twelve patients are alive at the time of this writing, with follow-up periods from 3 to 24 years (median 8 years). Among the 12 survivors, the Barthel Index scores were normal (100) in 11 patients and 80 in 1 patient. A total of 25 tumor resections were performed. In 1 patient, further resection was performed 5 days after initial resection due to MRI-confirmed residual tumor. Another 5 patients underwent repeat tumor resection after MRI-confirmed progressive tumor disease and clinical deterioration ranging from 3 months to 4 years after the initial operation. Three of these 5 patients also underwent a third resection, and 1 of the 3 underwent a fourth operation. Six children received adjuvant therapy: local radiotherapy in 2 patients, chemotherapy in 3 patients, and both in 1 patient. Twelve (80%) of the 15 patients needed treatment for persistent hydrocephalus.
  
  
  CONCLUSIONS
  Selected cases of low-grade midbrain gliomas may clearly benefit from resection with favorable results, even for prolonged periods. Three patients in the present series died, one of whom had a prolonged survival period of 21 years. Among the 12 survivors, stable long-term results appeared obtainable in at least 9. One patient died of acute hemorrhage 8 months after initial resection; otherwise, rapid tumor progression and death were not observed. Forty percent of the patients received adjuvant treatment, with local radiotherapy, chemotherapy, or both.
authors.affiliation: Departments of 1 Neurosurgery.
authors.forename: Tryggve
authors.initials: T
authors.lastname: Lundar
authors.forename: Bernt Johan
authors.initials: BJ
authors.lastname: Due-Tønnessen
authors.forename: Arild
authors.initials: A
authors.lastname: Egge
authors.forename: David
authors.initials: D
authors.lastname: Scheie
authors.forename: Petter
authors.initials: P
authors.lastname: Brandal
authors.forename: Einar
authors.initials: E
authors.lastname: Stensvold
authors.forename: Paulina
authors.initials: P
authors.lastname: Due-Tønnessen
mesh_terms: D000203:Activities of Daily Living; D000293:Adolescent; D020295:Brain Stem Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D018450:Disease Progression; D004522:Educational Status; D004651:Employment; D005260:Female; D005500:Follow-Up Studies; D005910:Glioma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007223:Infant; D008279:Magnetic Resonance Imaging; D008297:Male; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local; D019635:Neurosurgical Procedures / Q000009:adverse effects; D009664:Norway / Q000453:epidemiology; D011597:Psychomotor Performance; D012086:Reoperation; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome
keywords: NF1 = neurofibromatosis Type 1; long-term results; low-grade midbrain glioma; oncology; pediatric neurosurgery