Infarction following chiasmatic low grade glioma resection

The current SIOP (International Society for Paediatric Oncology)-LGG (low grade glioma) study protocol allows chiasmatic tumours identified as LGG on the basis of neuroradiological characteristics to be treated without histological verification. As some tumours do not respond well to treatment, the search for molecular tissue markers will gain importance for future studies. Anecdotal observations of infarctions after surgery for chiasmatic tumours during central reviewing initiated this study.

In 84 patients, histology was obtained during 102 interventions in the years 1992-2009 by 33 biopsies, 67 partial/subtotal and 2 total resections. Median age at the time of operation was 5 years (mean 5 years 11 months). We could identify 17 infarctions following partial resection of chiasmatic LGG. Biopsies were not complicated by infarction. Children developing infarction were considerably younger (median 3 years; mean 4 years 5 months) than the patients without infarction (median 5 years 4 months; mean 6 years 2 months). A total of 51 patients with cerebellar LGG (median 7 years; mean 7 years 4 months) served as a control group, with 65 surgical procedures (2 biopsies, 22 partial/subtotal resections and 41 total resections) performed in the years 2004-2009. Only one total resection (1.5%) in this group was followed by infarction.

Partial/subtotal resections of chiasmatic LGG in our study population bear a considerable risk for infarction especially in young children. As there is currently no evidence for a better outcome after tumour resection, we suggest that the sampling of tumour tissue should be performed via biopsies whenever possible.