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Incidental Brain Tumors in the Pediatric Population: A Systematic Review and Reappraisal of Literature
Fareed Jumah1, Michael S Rallo2, Travis Quinoa2
1Department of Neurosurgery, Rutgers-Robert Wood Johnson Medical School University Hospital, New Brunswick, New Jersey, USA.
Objectives:
Management of incidental asymptomatic brain tumors in children is controversial due to lack of clear evidence-based guidelines. We present this systematic review in an attempt to highlight an optimal treatment paradigm.
Methods:
This systematic review was conducted in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Databases were searched up to August 2019 using the keywords "incidental," "brain tumor," and "pediatric." Our main focus was on brain lesions suspected for neoplasm, diagnosed incidentally on neuroimaging in an otherwise asymptomatic patient <18 years old. Cystic, vascular, and inflammatory brain lesions were excluded.
Results:
Fourteen studies comprising 308 patients were included. All cases were diagnosed using magnetic resonance imaging. The most common indications for imaging were headache (93; 30%) and trauma (72; 23%). Lesion distribution was supratentorial (179; 58%), infratentorial (121; 40%), and intraventricular (8; 3%). Of 308 cases, 243 (79%) were managed with neuroradiological surveillance and 57 (19%) by upfront surgical excision. Of those managed conservatively, 177 (73%) remained stable within a mean follow-up of 30 months, 54 (22%) progressed, and 12 (5%) spontaneously regressed. Meanwhile, upfront excision achieved complete remission in all 57 cases over a mean follow-up of 68.3 months.
Conclusion:
A small body of evidence has emerged, highlighting the marked heterogeneity and contradictory results between the available studies, limiting our ability to draw solid conclusions. At this point, the decision between surgery and "watchful waiting" should be tailored on an individual patient basis depending on suspicion of malignancy, clinical or radiologic progression, and parental preference.
Insights
Management of incidental pediatric brain tumors remains controversial. This systematic review suggests treatment decisions should be individualized based on malignancy suspicion and patient factors, not solely on guidelines.
Area of Science:
- Pediatric neuro-oncology
- Neurosurgery
- Radiology
Background:
- Management of incidental asymptomatic pediatric brain tumors lacks clear evidence-based guidelines.
- This uncertainty creates controversy regarding optimal treatment paradigms.
Purpose of the Study:
- To systematically review existing literature on incidental pediatric brain tumors.
- To identify an optimal treatment paradigm for these lesions.
Main Methods:
- Systematic review adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
- Searched databases up to August 2019 for pediatric incidental brain tumors, excluding cystic, vascular, and inflammatory lesions.
- Included 14 studies with 308 pediatric patients.
Main Results:
- Magnetic resonance imaging (MRI) diagnosed all lesions.
- Most common indications for imaging were headache and trauma.
- Neoradiological surveillance was used in 79% of cases, with 73% remaining stable.
- Upfront surgical excision in 19% of cases achieved complete remission in all patients.
Conclusions:
- Limited evidence and heterogeneous results hinder definitive conclusions.
- Treatment decisions for incidental pediatric brain tumors require individualized assessment.
- Factors include suspicion of malignancy, clinical/radiological progression, and parental preference.
