title: Diffuse Intrinsic Pontine Glioma in Children: Document or Treat?
abstract: BACKGROUND
  The place of stereotactic biopsies in the management of diffuse intrinsic pontine gliomas (DIPGs) in children has changed over the years. Nonetheless, stereotactic biopsy remains a surgical procedure with its risks. One complication that has not been reported previously in case of a biopsy of a DIPG is metastatic seeding along the tract of the biopsy. We report the first 2 cases in the literature.
  
  
  METHODS
  One 8-year-old and one 9-year-old boy were admitted for a typical DIPG. Parents choose to be included into a research protocol that required a stereotactic biopsy. The biopsy was performed in both cases without any intraoperative complications, and they both received their treatment according to protocol. Unfortunately, 3 and 1 months respectively after the biopsy, their clinical condition deteriorated. MRI showed a metastatic seeding along the tract of the biopsy, and both patients died of disease progression.
  
  
  CONCLUSIONS
  The era of targeted therapy with molecular and genomic discoveries has paved the way to a research protocol that requires a biopsy from the patient. The reported complications have never been described before. The purpose of this paper is not to suggest that no biopsy should be performed when a DIPG is suspected. For now, biopsy remains investigational, because no benefit in survival could be drawn so far for any patient. This subject deserves honest discussion with the children and their parents.
authors.affiliation: Department of Pediatric Neurosurgery, Hôpital Femme Mère Enfant, Lyon Cedex, France. Electronic address: pierre-aurelien.beuriat@neurochirurgie.fr.
authors.forename: Beuriat
authors.initials: B
authors.lastname: Pierre-Aurélien
authors.affiliation: Department of Pediatric Neurosurgery, Hôpital Femme Mère Enfant, Lyon Cedex, France.
authors.forename: Szathmari
authors.initials: S
authors.lastname: Alexandru
authors.affiliation: Department of Pediatric Neurosurgery, Hôpital Femme Mère Enfant, Lyon Cedex, France.
authors.forename: Di Rocco
authors.initials: DR
authors.lastname: Federico
authors.affiliation: Pediatric Haematology and Oncology Unit, University Hospital, Clermont-Ferrand, France; INSERM-CIC 1405, CRECHE Unit, Clermont-Ferrand, France; Auvergne University, Clermont1 University, Faculty of Medicine, Clermont-Ferrand, France.
authors.forename: Kanold
authors.initials: K
authors.lastname: Justyna
authors.affiliation: Department of Pediatric Neurosurgery, Hôpital Femme Mère Enfant, Lyon Cedex, France.
authors.forename: Mottolese
authors.initials: M
authors.lastname: Carmine
authors.affiliation: Pediatric Institutes of Haematology-Oncology, Lyon, France.
authors.forename: Frappaz
authors.initials: F
authors.lastname: Didier
mesh_terms: D020295:Brain Stem Neoplasms / Q000473:pathology*; D002648:Child; D000066491:Clinical Decision-Making / Q000379:methods*; D003937:Diagnosis, Differential; D004282:Documentation; D017809:Fatal Outcome; D005910:Glioma / Q000473:pathology*; D006801:Humans; D061705:Image-Guided Biopsy / Q000379:methods*; D008297:Male; D018579:Patient Selection; D018570:Risk Assessment / Q000379:methods; D013238:Stereotaxic Techniques; D057832:Watchful Waiting / Q000379:methods*
keywords: Biopsy; Complications; Diffuse intrinsic pontine glioma; Pediatric