LG-05INCIDENTALLY FOUND CNS LESIONS IN PEDIATRICS: ADDRESSING A CURRENT TREATMENT DILEMMA

Abstract

Increased frequency of imaging in the pediatric population has led to an increase in the number of incidentally found CNS lesions. These lesions are a treatment dilemma for physicians and cause emotional strain for patients and families. Adult population data support initial surveillance of these incidentally found low grade lesions; however, similar pediatric research has been relatively limited due to sample size. Pediatric records were reviewed at All Children's Hospital, a tertiary free-standing children's hospital, for incidentally found CNS lesions. Demographic data, presenting symptoms, treatment approach, and outcomes were reviewed for 55 patients. Seventeen patients had biopsies or excision upon diagnosis due to imaging characteristics concerning for a high grade lesion. Thirty-nine patients underwent radiographic observation (average 35.5 months) and only 1 patient went on to require surgical intervention. Surgical pathology showed only one high grade lesion (ependymoma WHO grade 3) of those who underwent surgical evaluation. The presenting symptoms of a majority of the patients (67%) were headache, trauma, syncope, and seizure. The majority of the lesions were located in the posterior fossa (28/55). Of the 39 study patients that were monitored radiographically only 7 showed an increase in the overall size of the lesion and only 1 required surgical intervention. The remaining patients showed stable disease or spontaneous improvement. This data represents a large single center study that significantly contributes to prior published data and further supports surveillance as the best initial management of incidentally found lesions in the pediatric population.