Ziabchenko V. Primitive neuroectodermal tumors of supratentorial localization in children

The thesis presents a summary and solution of the topical issue of pediatric neurosurgery - increasing of efficiency of diagnostics and improving treatment outcomes of children with supratentorial primitive neuroectodermal brain tumors. The paper is based on the analysis of examination materials and treatment results of children with supratentorial PNET, who underwent in-patient treatment in SI "Acad.A.P.Romodanov Institute of Neurosurgery NAMS of Ukraine" between 1990 and 2012. Among them boys - 43 (59%), girls - 30 (41%). The disease most often begins with manifestation of hypertensive (68.5%), convulsions (64.4%) and the focal deficits (63%). The expediency of combining different neuroimaging methods of examination of children with supratentorial primitive neuroectodermal brain tumors were grounded. Axial and/or spiral CT as the primary research carried out in 71 (97.3%) patients, MRI - in 61 (84%), NSG - in 11 (15.1%) patients. Refined features of localization, distribution and growth direction of supratentorial primitive neuroectodermal brain tumors in children of different ages. The most frequently sPNET localized in the frontal lobe - in 18 (24.7%) patients, less often - in the occipital - in 2 (2.7%), in 33 (45.2%) patients were defeated several lobes of the brain. Visually complete tumor removal performed in 48 (65.8%) cases, subtotal - in 19 (26%), partial - in 4 (5.5%) cases. Stereotactic biopsy performed in 2 cases (2.7%). Postoperative mortality was 5.5%. Reoperation for continued growth of sPNET was performed in 9 (12.3%) patients. A significant reduction manifestations of intracranial hypertension with 68.5% to15,1%, reduction the frequency of convulsions from 64.4% to 24.7% and focal deficit from 63% to 20.5% in the postoperative period shows the high efficiency of surgical treatment. Histological features of supratentorial primitive neuroectodermal tumors of the brain in different age groups of children were described. The use of the entire spectrum of medical measures - maximum removal of the tumor in combination with radiation and chemotherapy increases the duration (one-year survival rate - 87.2%, three-year - 50%, five-year - 36.8%) and the quality of life of patients with sPNET. Results of the study have improved the efficiency and outline ways to further improve of diagnostics and surgical treatment sPNET in children.