Microsurgical treatment of pediatric medullary gliomas and its prognostics: a report of 18 cases

Abstract

Objective To explore the clinical features and prognosis factors of microsurgery treatment of pediatric medullary gliomas. Methods Clinical data of 18 patients with pediatric medullary gliomas who underwent microsurgical treatment at the Department of Neurosurgery, Beijing Tiantan Hospital of Capital Medical University from January 2008 to October 2013 were retrospectively analyzed in this study. Regular postoperative follow-up was conducted and the following informations including the patients' symptomatic outcome, tumor recurrence, survival time and cause of death were documented. Prognosis factor analysis of the patient's postoperative survial time was conducted. Results Among the 18 patients, gross total resection was achieved in 4 cases, subtotal resection in 9 cases and partial resection in 5 cases. Postoperative pathological findings confirmed the diagnosis of glioma in all cases, which, according to the World Health Organization (WHO) criteria, included a case of grade Ⅰ (pilocytic astrocytoma), 14 cases of grade II (12 astrocytomas and 2 oligodendrogliomas), 2 cases of grade III (anaplastic astrocytomas) and 1 case of grade IV (glioblastoma). The follow-up period was 4-103 months, with a median of (38.2 ± 29.9) months. Six cases died of tumor recurrence. The 1-year and 5-year survival rates were 75.6% and 63.0%, respectively. The mean survival time was (70.4 ± 10.7) months. The pathological grade [RR(95.0% CI)=127.613(2.365-6885.170), P<0.001] and extent of resection [RR(95.0% CI)=12.408(1.361-113.150), P=0.008] were determined to be independent factors affecting the patients' outcomes. Conclusion Pediatric medullary gliomas seemed mostly low grade, and the pathological grade and extent of resection might serve as important prognostic factors. Key words: Medulla oblongata; Glioma; Child; Microsurgery; Prognosis