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Biopsy and laser ablation as a treatment strategy for pediatric brain incidentalomas
Hunter S Futch1,2, Arman Jahangiri3,4, Youssef M Zohdy3,4
1Department of Neurosurgery, Emory University, Atlanta, GA, USA. hfutch@emory.edu.
Purpose:
To evaluate a combined biopsy-ablation procedure as an early intervention in small brain incidentalomas.
Methods:
Patient selection criteria included lesion in deep location, lesion growing over time, and lesion over 1 cm but less than 1.5 cm in diameter. Four patients underwent robotic-assisted stereotaxic biopsy followed by laser interstitial thermal therapy (LITT). Patients were then followed with MRI over time.
Results:
At time of operation, patients' age was between 10 and 16 years. Biopsy revealed pilocytic astrocytoma (n = 2) and dysembryonic neuroepithelial tumor (DNET), and one specimen was indeterminate for pathological changes. Imaging follow-up was between 17 and 72 months. None of the lesions showed progression on repeat MRI.
Conclusions:
Based on published data, it can be expected that roughly 20% of small incidentalomas will grow on repeat imaging, with higher rates in patients with tumor syndromes such as neurofibromatosis. Early intervention via biopsy and ablation in selected cases can provide tissue diagnosis, alleviate family anxieties, and potentially prevent future morbidity in these patients with enlarging lesions.
