Инциденталомы головного мозга у детей: тактика ведения и систематический обзор

ВВЕДЕНИЕ. Широкое применение различных нейровизуализационных технологий привело к появлению целой группы случайных находок в головном мозге у детей с неизвестным прогностическим значением. Часть таких находок имеют радиологические характеристики неопластических образований головного мозга, представляя значительную проблему для выбора оптимальной тактики лечения.
ЦЕЛЬ. Выполнить системный обзор и оценить современный подход ведения пациентов со случайно обнаруженными образованиями головного мозга (инциденталомами) у детей.
МАТЕРИАЛЫ И МЕТОДЫ. Выполнен системный обзор в базах данных eLibrary, PubMed и Medline (NCBI), по ключевым словам, предполагающим случайно обнаруженную опухоль (инциденталому) головного мозга у детей. Анализ информации включал в себя частоту распространения, методы диагностики, тактику ведения и риск злокачественной трансформации инциденталом к моменту публикации на август 2024 г.
РЕЗУЛЬТАТЫ. Проанализировано 2213 статей, из них 78 полнотекстовых. В финальное исследование было включено 42 статьи. Инциденталомы головного мозга диагностируются в 0,2–5,7 % нейроизображений у детей и представляют собой относительно разнородную группу образований, в большинстве случаев являясь глиомами низкой степени злокачественности.
ЗАКЛЮЧЕНИЕ. Несмотря на то, что большинство из них имеют относительно доброкачественное течение, часть новообразований может прогрессировать, а в редких случаях может отмечаться злокачественная трансформация образования. В связи с этим пациентам с данными находками требуется тщательное наблюдение.

1. Geelhoed G. W., Druy E. M. Management of the adrenal “incidentaloma”. Surgeryю. 1982;(92):866–874. Available from: https://pubmed.ncbi.nlm.nih.gov/7135206/ [Accessed 09 December 2024].

2. Molitch M. E., Russell E. J. The pituitary “incidentaloma”. Ann Intern Med. 1990;(112):925–931. Doi: 10.7326/0003-4819-112-12-925 Available from: https://www.acpjournals.org/doi/10.7326/0003-4819-112-12-925 [Accessed 09 December 2024].

3. Perret C., Boltshauser E., Scheer I. et al. Incidental findings of mass lesions on neuroimages in children. Neurosurg Focus. 2011;(31). Doi: 10.3171/2011.9.FOCUS11121. Available from: https://thejns.org/focus/view/journals/neurosurg-focus/31/6/2011.9.focus11121.xml [Accessed 09 December 2024].

4. Gnekow A. K., Kandels D., Tilburg C. Van et al. SIOP-EBTG and GPOH Guidelines for Diagnosis and Treatment of Children and Adolescents with Low Grade Glioma. Klin Padiatr. 2019;(231):107–135. Doi: 10.1055/a-0889-8256. EDN: SKQSWA.

5. Soleman J., Constantini S., Roth J. Incidental brain tumor findings in children: prevalence, natural history, management, controversies, challenges, and dilemmas. Childs Nerv Syst. 2024. Doi: 10.1007/S00381-024-06598-Z. EDN: OORRJV.

6. Soleman J., Kozyrev D. A., Ben-Sira L. et al. Management of incidental brain tumors in children: a systematic review. Child’s Nervous System. 2020;(36):1607–1619. Doi: 10.1007/s00381-020-04658-8. EDN: UOCKRP.И КЛИНИЧЕСКИЕ СЛУЧАИ

7. Jumah F., Rallo M. S., Quinoa T. et al. Incidental Brain Tumors in the Pediatric Population: A Systematic Review and Reappraisal of Literature. World Neurosurg. 2020;(139):121–131. Doi: 10.1016/j.wneu.2020.02.178. Available from: https://www.sciencedirect.com/science/article/abs/pii/S1878875020304642 [Accessed 09 December 2024].

8. Graf W. D., Kayyali H. R., Abdelmoity A. T. et al. Incidental neuroimaging findings in nonacute headache. J Child Neurol. 2010;(25):1182–1187. Doi: 10.1177/0883073809353149. Available from: https://journals.sagepub.com/doi/10.1177/0883073809353149 [Accessed 09 December 2024].

9. Gupta S. N., Gupta V. S., White A. C. Spectrum of intracranial incidental findings on pediatric brain magnetic resonance imaging: What clinician should know?. World J Clin Pediatr. 2016;(5):262. Doi: 10.5409/WJCP.V5.I3.262. Available from: https://www.wjgnet.com/2219-2808/full/v5/i3/262.htm [Accessed 09 December 2024].

10. Jansen P. R., Dremmen M., van den Berg A. et al. Incidental Findings on Brain Imaging in the General Pediatric Population. N Engl J Med. 2017;(377):1593–1595. Doi: 10.1056/NEJMC1710724. Available from: https://www.nejm.org/doi/full/10.1056/NEJMc1710724 [Accessed 09 December 2024].

11. Kaiser D., Leach J., Vannest J. et al. Unanticipated findings in pediatric neuroimaging research: prevalence of abnormalities and process for reporting and clinical follow-up. Brain Imaging Behav. 2015;(9):32–42. Doi: 10.1007/S11682-014-9327-7. EDN: ZOTBNP.

12. Perret C., Boltshauser E., Scheer I. et al. Incidental findings of mass lesions on neuroimages in children. Neurosurg Focus. 2011;(31). Doi: 10.3171/2011.9.FOCUS11121. Available from: https://thejns.org/focus/view/journals/neurosurg-focus/31/6/2011.9.focus11121.xml [Accessed 09 December 2024].

13. Li Y., Thompson W. K., Reuter C. et al. Rates of Incidental Findings in Brain Magnetic Resonance Imaging in Children. JAMA Neurol. 2021;(78):578–587. Doi: 10.1001/JAMANEUROL.2021.0306. EDN: EOPOPI.

14. Dangouloff-Ros V., Roux C. J., Boulouis G. et al. Incidental Brain MRI Findings in Children: A Systematic Review and Meta-Analysis. AJNR Am J Neuroradiol. 2019;(40):1818–1823. Doi: 10.3174/AJNR.A6281 Available from: https://www.ajnr.org/content/40/11/1818.long [Accessed 09 December 2024].

15. Toker R. T., Mutlucan I. O., Tanrıverdi C., Demir A. B. MRI findings in children with migraine or tensiontype headache. BMC Pediatr. 2023;(23). Doi: 10.1186/S12887-023-04264-Y. Available from: https://bmcpediatr.biomedcentral.com/articles/10.1186/s12887-023-04264-y [Accessed 09 December 2024].

16. Marner L., Lundemann M., Sehested A. et al. Diagnostic accuracy and clinical impact of [18F] FET PET in childhood CNS tumors. Neuro Oncol. 2021;(23):2107–2116. Doi: 10.1093/NEUONC/NOAB096. EDN: RMOUSP.

17. Pirotte B. J. M., Lubansu A., Massager N. et al. Clinical interest of integrating positron emission tomography imaging in the workup of 55 children with incidentally diagnosed brain lesions. J Neurosurg Pediatr. 2010;(5):479–485. Doi: 10.3171/2010.1.PEDS08336. Available from: https://thejns.org/pediatrics/view/journals/j-neurosurg-pediatr/5/5/article-p479.xml [Accessed 09 December 2024].

18. Roth J., Soleman J., Paraskevopoulos D. et al. Incidental brain tumors in children: an international neurosurgical, oncological survey. Childs Nerv Syst. 2018;(34):1325–1333. Doi: 10.1007/S00381-018-3836-4. EDN: MFDYJD.

19. Wright E., Amankwah E. K., Winesett S. P. et al. Incidentally found brain tumors in the pediatric population: a case series and proposed treatment algorithm. J Neurooncol. 2019;(141):355–361. Doi: 10.1007/S11060-018-03039-1. EDN: UZSFIE.

20. Ali Z. S., Lang S. S., Sutton L. N. Conservative management of presumed low-grade gliomas in the asymptomatic pediatric population. World Neurosurg. 2014;(81):368–373. Doi: 10.1016/J.WNEU.2013.01.038. Available from: https://www.sciencedirect.com/science/article/abs/pii/S1878875013000995 [Accessed 09 December 2024].

21. Bredlau A. L., Constine L. S., Silberstein H. J. et al. Incidental brain lesions in children: to treat or not to treat? J Neurooncol. 2012;(106):589–594. Doi: 10.1007/S11060-011-0695-1 Available from: https://link.springer.com/article/10.1007/s11060-011-0695-1 [Accessed 09 December 2024].

22. Di Rocco C., Frassanito P., Tamburrini G. The never-ending struggle between the two souls of the neurosurgeon: to wait or to intervene. World Neurosurg. 2014;(81):268–270. Doi: 10.1016/J.WNEU.2013.02.073 Available from: https://www.sciencedirect.com/science/article/abs/pii/S1878875013003835?via%3Dihub [Accessed 09 December 2024].

23. Kozyrev D. A., Constantini S., Tsering D. et al. Pediatric posterior fossa incidentalomas. Childs Nerv Syst. 2020;(36):601–609. Doi: 10.1007/S00381-019-04364-0. EDN: SBWHVZ.

24. Pollack I. F. Management of low-grade gliomas in childhood. World Neurosurg. 2014;(81):265–267. Doi: 10.1016/J.WNEU.2013.01.104. EDN: SPZHRR.

25. Roth J., Keating R. F., Myseros J. S. et al. Pediatric incidental brain tumors: a growing treatment dilemma. J Neurosurg Pediatr. 2012;(10):168–174. Doi: 10.3171/2012.6.PEDS11451. Available from: https://thejns.org/pediatrics/view/journals/j-neurosurg-pediatr/10/3/article-p168.xml [Accessed 09 December 2024].

26. Zaazoue M. A., Manley P. E., Kapur K. et al. Natural History and Management of Incidentally Discovered Focal Brain Lesions Indeterminate for Tumor in Children. Neurosurgery. 2020;(86):357–365. Doi: 10.1093/NEUROS/NYZ078. Available from: https://journals.lww.com/neurosurgery/abstract/2020/03000/natural_history_and_management_of_incidentally.6.aspx [Accessed 09 December 2024].

27. Antkowiak L., Zimny M., Starszak K. et al. Surgical Treatment of Pediatric Incidentally Found Brain Tumors: A Single-Center Experience. Brain Sci. 2023;(13). Doi: 10.3390/BRAINSCI13050746. EDN: WSRKFA.

28. de Padua V., Alves V., Care M. M., Leach J. L. Incidental Thalamic Lesions Identified on Brain MRI in Pediatric and Young Adult Patients: Imaging Features and Natural History. AJNR Am J Neuroradiol. 2024;(45):211–217. Doi: 10.3174/AJNR.A8090. EDN: FGWONO.

29. Kozyrev D. A., Soleman J., Tsering D. et al. Pediatric thalamic incidentalomas: an international retrospective multicenter study. J Neurosurg Pediatr. 2021;(29):141–149. Doi: 10.3171/2021.6.PEDS20976. EDN: RHAJTA.

30. Greuter L., Guzman R., Soleman J. Pediatric and Adult Low-Grade Gliomas: Where Do the Differences Lie?. Children (Basel). 2021;(80. Doi: 10.3390/CHILDREN8111075. EDN: CWKSFH.

31. Mistry M., Zhukova N., Merico D. et al. BRAF mutation and CDKN2A deletion define a clinically distinct subgroup of childhood secondary high-grade glioma. J Clin Oncol. 2015;(33):1015–1022. Doi: 10.1200/JCO.2014.58.3922. EDN: UQQUYD.

32. Frazão L., Do Carmo Martins M., Nunes V. M. et al BRAF V600E mutation and 9p21: CDKN2A/B and MTAP co-deletions – Markers in the clinical stratification of pediatric gliomas. BMC Cancer. 2018;(18). Doi: 10.1186/S12885-018-5120-0. EDN: TBAAIU.

33. Castelo-Branco P., Choufani S., Mack S. et al. Methylation of the TERT promoter and risk stratification of childhood brain tumours: an integrative genomic and molecular study. Lancet Oncol. 2013;(14):534–542. Doi: 10.1016/S1470-2045(13)70110-4. EDN: RICALB.

34. Broniscer A., Baker S. J., West A. N. et al. Clinical and molecular characteristics of malignant transformation of low-grade glioma in children. J Clin Oncol. 2007;(25):682–689. Doi: 10.1200/JCO.2006.06.8213. EDN: MKQNLR.

35. Broniscer A. Malignant transformation of low-grade gliomas in children: lessons learned from rare medical events. J Clin Oncol. 2015;(33):978–979. Doi: 10.1200/JCO.2014.60.1823. Available from: https://ascopubs.org/doi/10.1200/JCO.2014.60.1823 [Accessed 09 December 2024].

36. Soleman J., Roth J., Ram Z. et al. Malignant transformation of a conservatively managed incidental childhood cerebral mass lesion: controversy regarding management paradigm. Childs Nerv Syst. 2017;(33):2169–2175. Doi: 10.1007/S00381-017-3566-Z. EDN: QQMQYK.

37. Avinash K., Thakar S., Aryan S. et al. Malignant Transformation of Pediatric Low-grade Gliomas: Report of Two Cases and Review of a Rare Pathological Phenomenon. Neurol India. 2019;(67):1100–1106. Doi: 10.4103/0028-3886.266259. EDN: PGXVBB.

38. Bale T. A., Sait S. F., Benhamida J. et al. Malignant transformation of a polymorphous low grade neuroepithelial tumor of the young (PLNTY). Acta Neuropathol. 2021;(141):123–125. Doi: 10.1007/S00401-020-02245-4.EDN: HXCANL.

39. Zabrodskaya Y. M., Sidorin V. S., Nikolaenko M. S., Samochernikh K. A. Tumor progression of diffuse median glioma with H3 K27 alteration from pilocytic astrocytoma to glioblastoma. Arkh Patol. 2022;(84):40–46. Doi: 10.17116/PATOL20228406140. EDN: GVCATC.

40. Alpers C. E., Davis R. L., Wilson C. B. Persistence and late malignant transformation of childhood cerebellar astrocytoma. Case report. J Neurosurg. 1982;(57):548–551. Doi: 10.3171/JNS.1982.57.4.0548 Available from: https://thejns.org/view/journals/j-neurosurg/57/4/article-p548.xml [Accessed 09 December 2024].

41. Dirks P. B., Jay V., Becker L. E. et al. Development of anaplastic changes in low-grade astrocytomas of childhood. Neurosurgery. 1994;(34):68–78. Doi: 10.1097/00006123-199401000-00010. Available from: https://journals.lww.com/neurosurgery/abstract/1994/01000/development_of_anaplastic_changes_in_low_grade.10.aspx [Accessed 09 December 2024].

42. Ishibashi K., Inoue T., Fukushima H. et al. Pediatric thalamic glioma with H3F3A K27M mutation, which was detected before and after malignant transformation: a case report. Childs Nerv Syst. 2016;(32):2433–2438. Doi: 10.1007/S00381-016-3161-8. Available from: https://link.springer.com/article/10.1007/s00381-016-3161-8 [Accessed 09 December 2024].

43. Jay V., Squire J., Becker L. E., Humphreys R. Malignant transformation in a ganglioglioma with anaplastic neuronal and astrocytic components. Report of a case with flow cytometric and cytogenetic analysis. Cancer. 1994;(11):2862–2868. Doi: 10.10 02 /10 97- 014 2(19 9 4 0 6 01)73:11< 2 8 62::a idcncr2820731133>3.0.co;2-5. Available from: https://acsjournals.onlinelibrary.wiley.com/doi/abs/10.1002/1097-0142(19940601)73:11%3C2862::AIDCNCR2820731133%3E3.0.CO%3B2-5 [Accessed 09 December 2024].

44. Zoeller G. K., Brathwaite C. D., Sandberg D. I. Malignant transformation of an optic pathway glioma without prior radiation therapy. J Neurosurg Pediatr. 2010;(5):507–510. Available from: https://thejns.org/pediatrics/view/journals/j-neurosurg-pediatr/5/5/article-p507.xml [Accessed 09 December 2024]. Doi: 10.3171/2009.12. PEDS09173.

45. Winograd E., Pencovich N., Yalon M. et al. Malignant transformation in pediatric spinal intramedullary tumors: case-based update. Childs Nerv Syst. 2012;(28):1679–1686. Doi: 10.1007/S00381-012-1851-4. EDN: RJICAN.

46. Unal E., Koksal Y., Cimen O. et al. Malignant glioblastomatous transformation of a low-grade glioma in a child. Childs Nerv Syst. 2008;(24):1385–1389. Available from: https://link.springer.com/article/10.1007/s00381-008-0716-3 [Accessed 09 December 2024]. Doi: 10.1007/S00381-008-0716-3.

47. Ueda F., Aburano H., Yoshie Y. et al. Malignant transformation of diffuse infiltrating glial neoplasm after prolonged stable period initially discovered with hypothalamic hamartoma. Neurol Neurochir Pol. 2015;(49):441–445. Available from: https://www.sciencedirect.com/science/article/abs/pii/S0028384315001401 [Accessed 09 December 2024]. Doi: 10.1016/J.PJNNS.2015.08.003.

48. Schwartz A. M., Ghatak N. R. Malignant transformation of benign cerebellar astrocytoma. Cancer. 1990;(65):333–336. Doi: 10.1002/1097-0142(19900115)65:2<333::aidcncr2820650225>3.0.co;2-3. Available from: https://acsjournals.onlinelibrary.wiley.com/doi/pdf/10.1002/1097-0142(19900115)65:2%3C333::AIDCNCR2820650225%3E3.0.CO;2-3 [Accessed 09 December 2024].

49. Parsa C. F., Givrad S. Juvenile pilocytic astrocytomas do not undergo spontaneous malignant transformation: grounds for designation as hamartomas. Br J Ophthalmol. 2008;(92):40–46. Doi: 10.1136/BJO.2007.125567. Available from: https://bjo.bmj.com/content/92/1/40 [Accessed 09 December 2024].

50. Mano Y., Kumabe T., Shibahara I. et al. Dynamic changes in magnetic resonance imaging appearance of dysembryoplastic neuroepithelial tumor with or without malignant transformation. J Neurosurg Pediatr. 2013;(11):518–525. Doi: 10.3171/2013.1.PEDS11449. Available from: https://thejns.org/pediatrics/view/journals/j-neurosurg-pediatr/11/5/article-p518.xml [Accessed 09 December 2024].

51. Kleinman G. M., Schoene W. C., Walshe T. M., Richardson E. P. Malignant transformation in benign cerebellar astrocytoma. Case report. J Neurosurg. 1978;(49):111–118. Doi: 10.3171/JNS.1978.49.1.0111. Available from: https://thejns.org/view/journals/j-neurosurg/49/1/article-p111.xml [Accessed 09 December 2024].

52. Kim N. R., Wang K. C., Bang J. S. et al. Glioblastomatous transformation of ganglioglioma: case report with reference to molecular genetic and flow cytometric analysis. Pathol Int. 2003;(53):874–882. Doi: 10.1046/J.1440-1827.2003.01574.X. EDN: EUGZGB.

53. Law I., Albert N. L., Arbizu J. et al. Joint EANM/EANO/RANO practice guidelines/SNMMI procedure standards for imaging of gliomas using PET with radiolabelled amino acids and [18F]FDG: version 1.0. Eur J Nucl Med Mol Imaging. 2019;(46):540–557. Doi: 10.1007/S00259-018-4207-9. EDN: ZKOKOE.

54. Artzi M., Gershov S., Ben-Sira L. et al. Automatic segmentation, classification, and follow-up of optic pathway gliomas using deep learning and fuzzy c-means clustering based on MRI. Med Phys. 2020;(47):5693–5701. Doi: 10.1002/MP.14489.

55. Perwein T., Gielen G. H., Kandels D. et al. LGG-32. Malignant transformation of pediatric low-grade glioma to secondary high-grade glioma – report from the german brain tumor studies. Neuro Oncol. 2024; (26). Doi: 10.1093/NEUONC/NOAE064.424. Available from: https://academic.oup.com/neuro-oncology/article/26/Supplement_4/0/7694939 [Accessed 09 December 2024].

56. Iyad N. S., Ahmad M., Alkhatib S. G., Hjouj M. Gadolinium contrast agents- challenges and opportunities of a multidisciplinary approach: Literature review. Eur J Radiol Open 11. 2023. Doi: 10.1016/J.EJRO.2023.100503. EDN: XAHQNS.И КЛИНИЧЕСКИЕ СЛУЧАИ

57. Иова А. С., Гармашов Ю. А., Крюков Е. Ю. и др. Транскраниальная ультрасонография (некоторые вопросы истории и место в современной нейромедицине) // Лучевая диагностика и терапия. 2022. Т. 13, № 1S. С. 165–165. [Iova A. S., Garamashov Yu. A., Kryukov E. Yu. Et al. Transcranial ultrasound (some issues of history and place in modern neuromedicine. Luchevaya diagnostika i terapiya = Diagnostic radiology and radiotherapy. 2022;13(1S):164–165. (In Russ.)]. Doi: 10.22328/2079-5343. EDN: AAWPOG DOI: 10.22328/2079-5343.