{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2024,11,6]],"date-time":"2024-11-06T05:27:30Z","timestamp":1730870850686,"version":"3.28.0"},"reference-count":16,"publisher":"Georg Thieme Verlag KG","issue":"02","license":[{"start":{"date-parts":[[2024,4,1]],"date-time":"2024-04-01T00:00:00Z","timestamp":1711929600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Neurol Surg Rep"],"published-print":{"date-parts":[[2024,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>\n          Introduction\u2003Relapsed acute lymphoblastic leukemia (ALL) involving the central nervous system (CNS) is a significant issue that contributes to both morbidity and mortality. Given the poor outcomes in patients with CNS relapse, understanding how ALL involving intracranial relapse presents and is treated is critical. Here, we present a complex case of relapsed recurrent ALL in a pediatric patient.<\/jats:p><jats:p>\n          Case Report\u2003An 11-year-old patient presented with double relapse of ALL in the form of an extensive skull base lesion and again with leptomeningeal disease. For the skull base lesion, she was treated nonsurgically with chemotherapy and radiation, which led to a remarkable reduction in the size of the lesion. However, she was found to have early recurrence with leptomeningeal enhancement resulting in hydrocephalus 5 months after completing therapy. A shunt was placed successfully. Currently, she is being managed with monthly intrathecal chemotherapy with cerebrospinal fluid sampling and bone marrow biopsies every 2 months.<\/jats:p><jats:p>\n          Discussion\u2003We report the significant effect of chemotherapy and radiotherapy in reducing the size of the extensive skull base lesion, saving the patient from the risks associated with surgery. This patient's initial relapse, with a large skull base lesion that had intracranial involvement, is an unusual presentation of relapsed ALL. The additional early recurrence of leptomeningeal disease further makes this case unique and the management even more nuanced. Here, we demonstrate a multidisciplinary approach for the successful treatment of our patient, which can help guide the management of similar patients in the future.<\/jats:p>","DOI":"10.1055\/a-2297-4265","type":"journal-article","created":{"date-parts":[[2024,4,1]],"date-time":"2024-04-01T22:44:17Z","timestamp":1712011457000},"page":"e48-e52","source":"Crossref","is-referenced-by-count":0,"title":["Nuanced Management of a Skull Base Tumor in the Setting of Relapsed Acute Lymphoblastic Leukemia"],"prefix":"10.1055","volume":"85","author":[{"given":"Geena","family":"Jung","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, New York, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emery","family":"Buckner-Wolfson","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, New York, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adit","family":"Tal","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, New York, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ryan","family":"Fatemi","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, New York, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Timothy","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, New York, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Genesis","family":"Liriano","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, New York, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrew","family":"Kobets","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, New York, United States"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2024,4,30]]},"reference":[{"issue":"01","key":"ref1","doi-asserted-by":"crossref","first-page":"6756","DOI":"10.1038\/s41598-020-63528-0","article-title":"Rates and trends of childhood acute lymphoblastic leukaemia: an epidemiology study","volume":"10","author":"A Kakaje","year":"2020","journal-title":"Sci Rep"},{"issue":"16","key":"ref2","doi-asserted-by":"crossref","first-page":"1677","DOI":"10.1016\/S1470-2045(15)00363-0","article-title":"Intravenous pegylated asparaginase versus intramuscular native 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Nguyen","year":"2008","journal-title":"Leukemia"},{"issue":"09","key":"ref8","doi-asserted-by":"crossref","first-page":"833","DOI":"10.1001\/jama.2021.0669","article-title":"Effect of postreinduction therapy consolidation with blinatumomab vs chemotherapy on disease-free survival in children, adolescents, and young adults with first relapse of B-cell acute lymphoblastic leukemia: a randomized clinical trial","volume":"325","author":"P A Brown","year":"2021","journal-title":"JAMA"},{"issue":"03","key":"ref9","doi-asserted-by":"crossref","first-page":"575","DOI":"10.1016\/j.bbmt.2015.10.016","article-title":"Implications and management of central nervous system involvement before allogeneic hematopoietic cell transplantation in acute lymphoblastic leukemia","volume":"22","author":"I Aldoss","year":"2016","journal-title":"Biol Blood Marrow Transplant"},{"issue":"01","key":"ref10","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1080\/10428194.2017.1326597","article-title":"Managing CNS disease in adults with acute lymphoblastic leukemia","volume":"59","author":"R A Larson","year":"2018","journal-title":"Leuk Lymphoma"},{"issue":"12","key":"ref11","doi-asserted-by":"crossref","first-page":"2751","DOI":"10.1038\/s41375-022-01714-x","article-title":"Central nervous system involvement in childhood acute lymphoblastic leukemia: challenges and solutions","volume":"36","author":"M Thastrup","year":"2022","journal-title":"Leukemia"},{"issue":"04","key":"ref12","doi-asserted-by":"crossref","first-page":"427","DOI":"10.1007\/s11912-022-01220-4","article-title":"Central nervous system involvement in adults with acute leukemia: Diagnosis, prevention, and management","volume":"24","author":"S Paul","year":"2022","journal-title":"Curr Oncol Rep"},{"issue":"10","key":"ref13","doi-asserted-by":"crossref","first-page":"e108107","DOI":"10.1371\/journal.pone.0108107","article-title":"Outcome of central nervous system relapses in childhood acute lymphoblastic 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impact of therapy for childhood acute lymphoblastic leukaemia on intelligence quotients; results of the risk-stratified randomized central nervous system treatment trial MRC UKALL XI","volume":"4","author":"C Halsey","year":"2011","journal-title":"J Hematol Oncol"}],"container-title":["Journal of Neurological Surgery 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