Professor Zeng Gao / Professor Martin Zhou: Are the Surgical Risks of Pediatric Gliomas High? Can Biopsies Cause Tumor Dissemination?

The Q&A column on pediatric gliomas invites experts in the field of childhood brain tumors to provide targeted answers to various questions about pediatric gliomas. Today, we present the 8th issue.

1. Can all gliomas be surgically removed?

Not all gliomas can be surgically removed. The possibility of surgical resection depends on several factors, including the tumor's location, nature, and size—whether it is located in functional areas, the brainstem, thalamus, etc. It also depends on its relationship with normal brain tissue, such as whether there are clear boundaries or if it is a diffuse intrinsic pontine glioma. Before surgery for pediatric gliomas, it is crucial to assess not only whether the surgery can be performed but also whether it should be done. For instance, in children with DIPG, we currently do not advocate for surgical resection because the risks of neurological deficits do not improve the prognosis for these patients.

2. Can biopsies cause tumor dissemination?

Although theoretically there is a risk of tumor cell dislodgement during biopsy procedures, multiple studies have shown that biopsy surgeries do not increase the rate of tumor dissemination in pediatric neuro-oncology compared to control groups that underwent no biopsy. With advancements in technology and standardization of biopsy procedures, the safety of pediatric neuro-oncology biopsies has further improved, and the associated risks have decreased.

3. Under what circumstances is a ventriculoperitoneal shunt needed?

A ventriculoperitoneal shunt can be used to treat the vast majority of hydrocephalus cases, but not all instances of hydrocephalus should be primarily treated with this procedure. Caution should be exercised when considering a ventriculoperitoneal shunt for hydrocephalus secondary to tumors, as some children may experience spontaneous resolution of hydrocephalus after tumor resection. In some cases, a third ventriculostomy may be the preferred initial procedure, while others may not be suitable candidates for shunt surgery due to the condition of their cerebrospinal fluid or abdominal environment.

4. In what situations is complete tumor resection difficult?

Whether a tumor can be completely removed is influenced by several factors: 1. Tumor location, for instance, tumors originating from the medulla oblongata in the brainstem are often not fully resectable due to their potential impact on vital respiratory functions, and widely disseminated tumors cannot be fully resected. 2. The boundaries between the tumor and normal brain tissue; some tumors exhibit diffuse growth, lacking clear boundaries with surrounding functional brain tissue, making complete resection impossible. 3. The tumor's blood supply and its relationship with adjacent vessels and nerves; if a tumor invades nearby blood vessels and nerves that cannot be sacrificed or compensated for, complete resection may not be feasible. 4. The general health of the child; if the child is in poor condition and unable to endure prolonged surgery or trauma, staged surgical treatment may be necessary, complicating the possibility of achieving complete tumor resection in one operation.

5. Are the surgical risks of pediatric gliomas high?

The risks associated with pediatric glioma surgery depend on multiple factors, including the tumor's location, its relationship with surrounding nerves, blood vessels, and normal brain tissue, tumor size, blood supply, and the child's age and overall health. The specific surgical risks for each child vary and need to be assessed by the attending physician based on the individual case. Generally, there will be detailed communication and explanation with the family prior to surgery.