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Biopsy of paediatric brainstem intrinsic tumours: Experience from a Singapore Children’s Hospital

  • Yuan Guang Lim
    Affiliations
    Department of Neurosurgery, National Neuroscience Institute, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore
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  • Enrica EK Tan
    Affiliations
    Paediatric Haematology/Oncology Service, KK Women’s and Children’s Hospital, 100 Bukit Timah Road, Singapore 229899, Singapore

    SingHealth Duke-NUS Paediatrics Academic Clinical Program, 100 Bukit Timah Road, Singapore 229899, Singapore
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  • Wen Shen Looi
    Affiliations
    Division of Radiation Oncology, National Cancer Centre, 31 Third Hospital Ave, Singapore 168753, Singapore
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  • Ru Xin Wong
    Affiliations
    Division of Radiation Oncology, National Cancer Centre, 31 Third Hospital Ave, Singapore 168753, Singapore
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  • Kenneth TE Chang
    Affiliations
    Department of Pathology and Laboratory Medicine, KK Women’s and Children’s Hospital, 100 Bukit Timah Road, Singapore 229899, Singapore
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  • David CY Low
    Affiliations
    Department of Neurosurgery, National Neuroscience Institute, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore

    Neurosurgical Service, KK Women’s and Children’s Hospital, 100 Bukit Timah Road, Singapore 229899, Singapore

    SingHealth Duke-NUS Neuroscience Academic Clinical Program, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore
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  • Wan Tew Seow
    Affiliations
    Department of Neurosurgery, National Neuroscience Institute, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore

    Neurosurgical Service, KK Women’s and Children’s Hospital, 100 Bukit Timah Road, Singapore 229899, Singapore

    SingHealth Duke-NUS Neuroscience Academic Clinical Program, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore
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  • Sharon YY Low
    Correspondence
    Corresponding author at: Neurosurgical Service, KK Women’s and Children’s Hospital, 100 Bukit Timah Road, 229899, Singapore.
    Affiliations
    Department of Neurosurgery, National Neuroscience Institute, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore

    Neurosurgical Service, KK Women’s and Children’s Hospital, 100 Bukit Timah Road, Singapore 229899, Singapore

    SingHealth Duke-NUS Neuroscience Academic Clinical Program, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore

    SingHealth Duke-NUS Paediatrics Academic Clinical Program, 100 Bukit Timah Road, Singapore 229899, Singapore
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      Highlights

      • Diffuse midline gliomas of the brainstem have devastating prognosis.
      • Biopsy of paediatric brainstem tumours is now considered a safe procedure.
      • This option can be considered for patients to identify relevant molecular markers for targeted therapy.

      Abstract

      Background

      Biopsy of intrinsic brainstem tumours presumed to be diffuse midline gliomas (previously known as DIPG) is controversial. Surgery has risks of injury to the eloquent brainstem and may not have direct benefit to the patient. Technological improvements in operative adjuncts have allowed the role of biopsy for paediatric brainstem lesions to be revisited with new insights. This study aims to evaluate our institutional experience in brainstem biopsy.

      Methods

      This is an ethics-approved retrospective study based in KK Women’s and Children’s Hospital. Patients diagnosed with intrinsic brainstem tumours and managed by the Neurosurgical Service were included. Variables of interest included patient demographics, neuroimaging features, type of surgery, histological and molecular diagnosis, treatment, and outcomes.

      Results

      From 2006 to 2021, a total of 27 brainstem intrinsic tumours were referred to the Neurosurgical Service. Eleven (40.7 %) patients underwent stereotactic biopsy and 10 (37 %) had open biopsies. Histologically, 10 (37 %) were confirmed to be high grade gliomas, eight (29.6 %) were low grade gliomas and 3 (11.1 %) were malignant embryonal tumours. No negative diagnostic results or permanent postoperative complications were encountered. Five patients went on to have their tumours interrogated via next-generation sequencing to look for targetable mutations. The remaining 6 (22.2 %) patients did not undergo biopsy, whereby 1 of them is still alive after 6 years.

      Conclusion

      Biopsy of paediatric brainstem intrinsic tumours is a safe procedure that concurrs with accurate tissue diagnosis. This option can be offered to affected patients, especially to identify relevant markers for targeted therapy.

      Keywords

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