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Mural tumors with cysts in the cerebral hemispheres of children
Insights
Mural tumors in children
Area of Science:
- Pediatric neurosurgery
- Neuroradiology
- Pediatric oncology
Background:
- Mural tumors, characterized by nodules within cysts in the cerebral hemisphere, present unique diagnostic and therapeutic challenges in pediatric patients.
- Understanding the nature of these lesions is crucial for effective management.
Observation:
- Computed tomography (CT) revealed well-enhanced mural nodules in thirteen pediatric cases.
- Cyst walls typically did not enhance, and importantly, were devoid of neoplastic cells, suggesting a non-invasive cystic component.
- Cerebral angiography demonstrated significant vascularity within the mural nodules in a subset of patients.
Findings:
- The study identified a spectrum of tumors including astrocytomas, ependymomas, choroid plexus papillomas, oncocytoma, hamartoma, and primitive neuroectodermal tumors.
- Preoperative angiography proved valuable in assessing the vascular supply of the mural nodules.
- Complete surgical removal of the mural nodule, sparing the cyst wall, resulted in excellent patient outcomes.
Implications:
- These findings underscore the importance of preoperative angiography for surgical planning in pediatric cerebral mural tumors.
- Surgical strategy focusing on mural nodule extirpation offers a favorable prognosis, minimizing morbidity associated with extensive cyst wall resection.
- This approach highlights a potentially less invasive method for treating these complex pediatric brain lesions.
Abstract:
Thirteen infants and children with mural tumors (i.e., cysts with mural nodules) in the cerebral hemisphere are presented. The tumors comprise five benign astrocytomas, three ependymomas, two choroid plexus papillomas, one oncocytoma, one hamartoma, and one primitive neuroectodermal tumor. Computed tomography showed well-enhanced mural nodules. Cyst walls did not enhance in any but one, in which the enhancement was attributed to hemorrhage in the cyst. None of the cyst walls contained neoplastic cells. Cerebral angiography was performed in all patients, and five showed extensive vascularity in the tumor nodule. The importance of preoperative angiography is emphasized. Total extirpation of the mural nodule without excision of the cyst wall led to excellent prognosis for these patients.