Pediatric brain tumor surgery: extent of resection and preservation of neurological function

Abstract

Safe maximal resection is desirable for pediatric brain tumors. Surgery should be performed with a proper understanding of the role of the extent of resection of the pediatric brain tumor. Medulloblastoma should be removed to the maximum extent with priority given to the preservation of neurological function. It should not be aggressively pursued at the cost of undue morbidity. There is no benefit of resection of residual tumors with sizes less than 1.5 cm². In atypical teratoid/rhabdoid tumors (AT/RTs), gross total resection is also a worthwhile goal and is associated with improved outcomes over those with significant residual disease. Neoadjuvant chemotherapy for AT/RTs might reduce both tumor size and vascularity, which enables maximal tumor resection. In pediatric low-grade gliomas, the goal is to achieve a complete cure by total resection, but priority may be given to the preservation of neurological function. Management based on genetic diagnosis is considered in pediatric low-grade gliomas. In pediatric brain tumor surgery, technological developments in various fields such as neuronavigation, tractography, functional magnetic resonance imaging (MRI) and intraoperative neuromonitoring enable safer and more maximal removal.