Related Experiment Video
Updated: Apr 12, 2026
Author Spotlight: Multimodal Imaging Strategies for Optimizing Drug Delivery and Early Detection in Glioblastoma Treatment
Published on: March 1, 2024
Second-look surgery for intracranial germ cell tumors
Hideki Ogiwara1, Chikako Kiyotani, Keita Terashima
1*Division of Neurosurgery, National Center for Child Health and Development, Tokyo, Japan; ‡Division of NeuroOncology, National Center for Child Health and Development, Tokyo, Japan.
Background:
The role of second-look surgery in intracranial germ cell tumors (GCTs) needs to be reviewed.
Objective:
To present our experience of second-look surgery in patients with intracranial GCTs who showed less than complete response despite normalizing or decreasing tumor markers after chemotherapy.
Methods:
Retrospective review of 7 patients who underwent second-look surgery for an intracranial GCT was performed.
Results:
Of 23 consecutive patients with newly diagnosed intracranial GCTs treated between August 2003 and August 2013, 7 patients (30%) underwent second-look surgery. The mean age was 9.4 years. The initial diagnoses were mixed germ cell tumor in 5 and immature teratoma in 2. Second-look surgery was performed after 1 to 3 courses of chemotherapy. Magnetic resonance imaging at the surgery demonstrated increasing residual tumor in 4 and stable residual tumor in 3. Tumor markers were normalized in 5 and nearly normalized in 2. Gross total resection was achieved in all patients. Histopathology at second-look surgery revealed mature teratoma in 5, fibrosis with atypical cells in 1, and fibrosis in 1. All patients subsequently underwent additional chemoradiation therapy according to the initial diagnosis. All patients are alive with no evidence of recurrence, with a mean follow-up of 48 months.
Conclusion:
Second-look surgery plays an important role in the treatment of intracranial GCTs. Surgery may be encouraged at a relatively early phase after chemotherapy when the residual tumor increases or does not change size despite normalized or nearly normalized tumor markers in order to achieve complete resection and improve outcome.
Insights
Second-look surgery is crucial for treating intracranial germ cell tumors (GCTs) when residual tumors persist after chemotherapy. Early surgical intervention improves outcomes by achieving complete resection in GCT patients.
Area of Science:
- Neuro-oncology
- Pediatric Oncology
- Surgical Oncology
Background:
- The clinical significance of second-look surgery for intracranial germ cell tumors (GCTs) requires further investigation.
- Optimal management strategies for GCTs with residual disease after chemotherapy are debated.
Purpose of the Study:
- To evaluate the efficacy and outcomes of second-look surgery in patients with intracranial GCTs.
- To assess the role of surgery in achieving complete tumor resection when markers normalize but residual disease is present.
Main Methods:
- Retrospective analysis of 7 patients with intracranial GCTs who underwent second-look surgery.
- Review of clinical data, imaging, tumor markers, and histopathology post-chemotherapy.
Main Results:
- Second-look surgery was performed on 7/23 (30%) patients after 1-3 chemotherapy courses.
- Gross total resection was achieved in all patients; histopathology revealed mature teratoma or fibrosis.
- All patients remain alive with no recurrence after a mean follow-up of 48 months.
Conclusions:
- Second-look surgery is a vital component in the management of intracranial GCTs.
- Early surgical intervention is recommended for residual GCTs, even with normalized tumor markers, to improve resection rates and patient outcomes.
More Related Videos
05:10Intracranial Orthotopic Allografting of Medulloblastoma Cells in Immunocompromised Mice
Published on: October 3, 2010
09:52An Orthotopic Glioblastoma Mouse Model Maintaining Brain Parenchymal Physical Constraints and Suitable for Intravital Two-photon Microscopy
Published on: April 21, 2014