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Journal of Neurosurgical Sciences 2021 Apr 16

DOI: 10.23736/S0390-5616.21.05169-9

Copyright © 2021 EDIZIONI MINERVA MEDICA

language: English

A single center experience in the management of progressive juvenile pilocytic astrocytoma

Ieta SHAMS 1, 2, Branavan MANORANJAN 1, 3 , Rebecca VOTH 1, Malavan RAGULOJAN 1, Olufemi AJANI 1, 4, Blake YARASCAVITCH 1, 4, Sheila K. SINGH 1, Adam J. FLEMING 1, 5

1 McMaster Pediatric Brain Tumor Study Group, McMaster University, Hamilton, ON, Canada; 2 University of Ottawa School of Medicine, University of Ottawa, Ottawa, ON, Canada; 3 Section of Neurosurgery, Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Canada; 4 McMaster Pediatric Brain Tumor Study Group, Department of Surgery, McMaster University, Hamilton, ON, Canada; 5 McMaster Pediatric Brain Tumor Study Group, Department of Pediatrics, McMaster University, Hamilton, ON, Canada


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BACKGROUND: Juvenile pilocytic astrocytoma (JPA) typically follows an indolent clinical course. The first-line treatment for most JPAs is surgical resection. However, a gross total resection may not be feasible for deep-seated lesions and/or infiltrative tumors, leading to multimodal treatment approaches that may be complicated by patient age and tumor location. Despite the prevalence of pediatric JPAs, there is no single approach to treating progressive disease.
METHODS: We investigated the multifaceted management of progressive JPAs through a retrospective analysis of JPAs treated at a single center over an 18-year period (1998-2016). All cases were categorized according to location, whether supratentorial or infratentorial, and for each case we calculated the number of interventions and the time between interventions.
RESULTS: We identified a total of 40 JPAs, (11 supratentorial, 29 infratentorial). Total number of interventions among all supratentorial JPA patients was 21 (average 2 interventions/patient). The total number of interventions among infratentorial JPAs was 40 (average 1.4 interventions/patient).
CONCLUSIONS: Treatment of progressive JPA is variable and may require numerous surgeries and adjuvant therapies.


KEY WORDS: Juvenile pilocytic astrocytoma; Neurosurgery; Neuro-oncology; Chemotherapy; Radiation

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