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Purpose <p>To evaluate a combined biopsy-ablation procedure as an early intervention in small brain incidentalomas.</p> Methods <p>Patient selection criteria included lesion in deep location, lesion growing over time, and lesion over 1&#xa0;cm but less than 1.5&#xa0;cm in diameter. Four patients underwent robotic-assisted stereotaxic biopsy followed by laser interstitial thermal therapy (LITT). Patients were then followed with MRI over time.</p> Results <p>At time of operation, patients’ age was between 10 and 16&#xa0;years. Biopsy revealed pilocytic astrocytoma (<i>n</i> = 2) and dysembryonic neuroepithelial tumor (DNET), and one specimen was indeterminate for pathological changes. Imaging follow-up was between 17 and 72&#xa0;months. None of the lesions showed progression on repeat MRI.</p> Conclusions <p>Based on published data, it can be expected that roughly 20% of small incidentalomas will grow on repeat imaging, with higher rates in patients with tumor syndromes such as neurofibromatosis. Early intervention via biopsy and ablation in selected cases can provide tissue diagnosis, alleviate family anxieties, and potentially prevent future morbidity in these patients with enlarging lesions.</p>

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Biopsy and laser ablation as a treatment strategy for pediatric brain incidentalomas

  • 期刊论文

  • 发表日期：

    2025年12月15日

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  • Hunter S. Futch,
  • Arman Jahangiri,
  • Youssef M. Zohdy,
  • Jennifer Wheelus,
  • Andrew Reisner,
  • Jacob R. Lepard,
  • Joshua J. Chern

摘要

Purpose

To evaluate a combined biopsy-ablation procedure as an early intervention in small brain incidentalomas.

Methods

Patient selection criteria included lesion in deep location, lesion growing over time, and lesion over 1 cm but less than 1.5 cm in diameter. Four patients underwent robotic-assisted stereotaxic biopsy followed by laser interstitial thermal therapy (LITT). Patients were then followed with MRI over time.

Results

At time of operation, patients’ age was between 10 and 16 years. Biopsy revealed pilocytic astrocytoma (n = 2) and dysembryonic neuroepithelial tumor (DNET), and one specimen was indeterminate for pathological changes. Imaging follow-up was between 17 and 72 months. None of the lesions showed progression on repeat MRI.

Conclusions

Based on published data, it can be expected that roughly 20% of small incidentalomas will grow on repeat imaging, with higher rates in patients with tumor syndromes such as neurofibromatosis. Early intervention via biopsy and ablation in selected cases can provide tissue diagnosis, alleviate family anxieties, and potentially prevent future morbidity in these patients with enlarging lesions.