Neuroblastoma with intracerebral metastases and the need for neurosurgery: a single-center experience

Steffen Fleck; Sascha Marx; Clara Bobak; Victoria Richter; Stephan Nowak; Ehab El Rafaee; Nikolai Siebert; Karoline Ehlert; Henry W S Schroeder; Holger N Lode

doi:10.3171/2019.7.PEDS19143

Neuroblastoma with intracerebral metastases and the need for neurosurgery: a single-center experience

J Neurosurg Pediatr. 2019 Oct 11:1-6. doi: 10.3171/2019.7.PEDS19143. Online ahead of print.

Authors

Affiliations

¹ Departments of1Neurosurgery and.
² 3Department of Neurosurgery, Cairo University, Giza, Egypt.
³ 2Pediatric Oncology, University Medicine Greifswald, Germany; and.

PMID: 31604318
DOI: 10.3171/2019.7.PEDS19143

Abstract

Objective: Intracerebral metastases in neuroblastoma patients are rare, and information about the indication for and the outcome of neurosurgical procedures in this setting is scarce in the literature. The authors' aim in the present study was to report a single-center experience with the neurosurgical treatment of intracerebral metastases in neuroblastoma.

Methods: This study is a retrospective single-center analysis of all neurosurgical strategies used in the treatment of intracerebral metastases in neuroblastoma patients.

Results: Between 2009 and 2017, 237 pediatric patients (94 girls, 143 boys) with a mean age of 39 months at diagnosis were treated for neuroblastoma. Five (2.1%) of the 237 patients had a neurosurgical procedure for intracerebral metastases. The metastases occurred a mean of 46 months after initial diagnosis. All of these patients had neuroblastoma stage 4. Indications for surgery were recurrent metastases after initial successful oncological treatment or progression of the metastasis under oncological treatment as well as deterioration of neurological function. Intraoperatively, the tumor usually had a distinguishable dissection plane but was infiltrative to adjacent nerves in some spots. Mean overall survival after the neurosurgical procedure was 22 months. Furthermore, in another 3 patients, a neurosurgical procedure was done for an intracranial but extracerebral metastasis.

Conclusions: Neurosurgical procedures for intracerebral metastases in neuroblastoma patients are rare and were performed in 2.1% of patients in the present study. Intracerebral metastases occurred during disease progression, and the prognosis after surgery was very limited. The main indications for surgery were rapid neurological deterioration or recurrence of the metastasis after initial successful oncological treatment. Intraoperatively, the metastases usually had a distinguishable dissection plane from the normal brain tissue.

Keywords: CTX = chemotherapy; GTR = gross-total resection; RTX = radiotherapy; STR = subtotal resection; cranial; intracerebral metastases; neuroblastoma; neurosurgical treatment; oncology.