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World Neurosurg. 2016 Sep;93:485.e11-4. doi: 10.1016/j.wneu.2016.07.011. Epub 2016 Jul 12.

Diffuse Intrinsic Pontine Glioma in Children: Document or Treat?

Author information

1
Department of Pediatric Neurosurgery, Hôpital Femme Mère Enfant, Lyon Cedex, France. Electronic address: pierre-aurelien.beuriat@neurochirurgie.fr.
2
Department of Pediatric Neurosurgery, Hôpital Femme Mère Enfant, Lyon Cedex, France.
3
Pediatric Haematology and Oncology Unit, University Hospital, Clermont-Ferrand, France; INSERM-CIC 1405, CRECHE Unit, Clermont-Ferrand, France; Auvergne University, Clermont1 University, Faculty of Medicine, Clermont-Ferrand, France.
4
Pediatric Institutes of Haematology-Oncology, Lyon, France.

Abstract

BACKGROUND:

The place of stereotactic biopsies in the management of diffuse intrinsic pontine gliomas (DIPGs) in children has changed over the years. Nonetheless, stereotactic biopsy remains a surgical procedure with its risks. One complication that has not been reported previously in case of a biopsy of a DIPG is metastatic seeding along the tract of the biopsy. We report the first 2 cases in the literature.

CASE DESCRIPTION:

One 8-year-old and one 9-year-old boy were admitted for a typical DIPG. Parents choose to be included into a research protocol that required a stereotactic biopsy. The biopsy was performed in both cases without any intraoperative complications, and they both received their treatment according to protocol. Unfortunately, 3 and 1 months respectively after the biopsy, their clinical condition deteriorated. MRI showed a metastatic seeding along the tract of the biopsy, and both patients died of disease progression.

CONCLUSIONS:

The era of targeted therapy with molecular and genomic discoveries has paved the way to a research protocol that requires a biopsy from the patient. The reported complications have never been described before. The purpose of this paper is not to suggest that no biopsy should be performed when a DIPG is suspected. For now, biopsy remains investigational, because no benefit in survival could be drawn so far for any patient. This subject deserves honest discussion with the children and their parents.

KEYWORDS:

Biopsy; Complications; Diffuse intrinsic pontine glioma; Pediatric

PMID:
27422681
DOI:
10.1016/j.wneu.2016.07.011
[Indexed for MEDLINE]

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