Introduction: Juvenile pilocytic astrocytoma (JPA) is the most frequently diagnosed histologic subtype of all pediatric brain tumors with an annual incidence of 0.8 per 100,000 according to the Central Brain Tumor Registry of the United States. The current lack of consensus on post-operative imaging in juvenile pilocytic astrocytoma (JPA) patients poses a unique dilemma for small-to-medium sized academic neurosurgical centers. These centers tend to have less in-house data and experience to support the use of costly imaging protocols. To establish better-informed imaging guidelines at our hospital, we conducted a retrospective study of post-operative MRI features in a cohort of children who underwent craniotomy for JPA resection.
Methods: The medical records of children who had undergone craniotomy for resection of JPA from 2000 to 2012 were reviewed. Preoperative imaging characteristics were recorded for comparison to postoperative imaging findings. Tumor recurrence, growth, and regression were analyzed and meticulously recorded. Frequency of imaging studies for individual patients were also recorded.
Results: Twelve patients were identified to have undergone craniotomy for JPA resection between 2000 and 2012. All tumors irrespective of extent of resection or use of adjuvant stereotactic radiosurgery (SRS), either failed to recur, were stable in their size, or regressed over the study period. Post-operative imaging frequency and timing varied greatly between patients.
Conclusions: Our results suggest that post-operative imaging frequency in pediatric patients with JPA can be greatly relaxed independently of factors such as extent of resection or use of SRS. Larger studies are needed to define optimal post-operative imaging frequency protocols that can balance clinical utility and cost-effectiveness.
Patient Care: JPAs are benign tumours that occur typically in the younger pediatric population. They typically behave in a benign fashion and rarely recur after reseection. Although JPAs rarely progress, there is a great amount of anxiety around frequent imaging for families involved. Developing more clear and evidence based treatment imaging guidelines for these benign tumours with low recurrence risk will allow for small facilities with neurosurgical departments to more judiciously manage their resources while at the same time provide the greatest amount of clinical utility for the neurosurgeon and patient alike.
Learning Objectives: By conclusion of this session, participants will:
1) Recognize that recurrence of JPA after resection is a rare occurrence.
2) Recognize the need for more judicious use of imaging technologies in post-operative JPA patients.
3) Appreciate that smaller neurosurgical centers are faced with tighter resource restrictions and less data to support use of costly imaging studies.