Management of Posterior Circulation Aneurysms

Abstract

INTRODUCTION: Malignant astrocytomas in children are relatively uncommon, with only a minority occurring in the supratentorial region. Studies on these tumors are few and limited. We set out to ascertain factors associated with recurrence and survival in pediatric patients with supratentorial malignant astrocytomas. METHODS: Thirty-seven consecutive pediatric patients (<18 yr) undergoing surgical resection of a supratentorial malignant astrocytoma (World Health Orgnization Grade III or IV) at a single institution were retrospectively reviewed. The association of clinical, radiographic, operative, and postoperative variables with progression-free survival (PFS) and overall survival (OS) was assessed via proportional-hazards regression analysis. RESULTS: Mean age was 12.9 ± 3.6 years at the time of surgery. Twenty-four (65%) and 13 (35%) patients had pathology consistent with a glioblastoma (GBM) and an anaplastic astrocytoma (AA), respectively. A new perioperative neurological deficit occurred in three (8%) cases. There was no perioperative mortality. After resection of a GBM, the median PFS and OS were 9.4 and 12.6 months, respectively. After resection of an AA, the 5-year PFS and OS rates were 42 and 74%, respectively. Variables associated with prolonged PFS and OS (P < 0.05) included: AA versus GBM, gross total (GTR) versus subtotal resection (STR), and postoperative Temodar/radiation therapy versus all other adjuvant therapies. In addition, tumor diameter greater than 3cm was associated with decreased PFS (P < 0.05), and preoperative symptom duration less than 1 month was associated with decreased OS (P < 0.05). CONCLUSION: Survival after resection of pediatric AAs may be favorable compared with adult AAs. In our experience, GTR with postoperative Temodar/radiation therapy was associated with the greatest overall survival in patients with either AAs or GBMs. The findings in this study may offer useful insight into those factors that contribute to recurrence and survival in pediatric patients with supratentorial malignant astrocytomas and may guide treatment strategies aimed at delaying recurrence and preserving survival.