{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T23:16:00Z","timestamp":1790810160952,"version":"4.1.0"},"reference-count":52,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[1998,7]]},"abstract":"<jats:p content-type=\"fine-print\"><jats:italic>Object.<\/jats:italic>One hundred seventy-two children with high-grade astrocytomas were treated by members of the Children's Cancer Group in a prospective randomized trial designed to evaluate the role of two chemotherapy regimens. Seventy-six percent of the patients (131 children) in whom a diagnosis of either anaplastic astrocytoma or glioblastoma multiforme was confirmed by central pathological review are the subject of this report.<\/jats:p><jats:p content-type=\"fine-print\"><jats:italic>Methods.<\/jats:italic>Patients were stratified according to the extent of tumor resection (biopsy [&lt; 10%], partial resection [10\u201350%], subtotal resection [51\u201390%], near-total resection [&gt; 90%], and total resection) as determined by surgical observation and postoperative computerized tomography scanning. Information on contemporary neurosurgical management was obtained from the patient's operative records and standardized neurosurgical report forms.<\/jats:p><jats:p content-type=\"fine-print\">The vast majority of tumors were supratentorial: 63% (83 tumors) in the superficial cerebral hemisphere, 28% (37 tumors) in the deep or midline cerebrum, and only 8% (11 tumors) in the posterior fossa. A significant association was detected between the primary tumor site and the extent of resection (p &lt; 0.0001). A radical resection (&gt; 90%) was performed in 37% of the children: 49% of the tumors in the superficial hemisphere and 45% of tumors in the posterior fossa compared with 8% of midline tumors. Tumor location could also be used to predict the need for both temporary and permanent cerebrospinal fluid (CSF) diversion. Half of the deep tumors and 8% of the hemispheric astrocytomas ultimately required a permanent CSF shunt.<\/jats:p><jats:p content-type=\"fine-print\">Improvement in preoperative neurological deficits and level of consciousness was seen in 36% and 34% of the children, respectively. New or increased deficits were present in 14% of the children, with 6% experiencing a diminished sensorium after surgery. Postoperative nonneurological complications were rare: infection, hematoma, and CSF fistula each occurred in 1.7% of the children.<\/jats:p><jats:p content-type=\"fine-print\">Univariate and multivariate analyses demonstrated that radical tumor resection (&gt; 90%) was the only therapeutic variable that significantly improved progression-free survival (PFS) rates. For all patients with malignant astrocytomas, the distributions of PFS rates were significantly different (p = 0.006) following radical resection compared with less extensive (&lt; 90%) resection. The 5-year PFS rates were 35 \u00b1 7% and 17 \u00b1 4%, respectively. The differences in the distribution of PFS rate were significant for the subsets of patients with anaplastic astrocytoma (p = 0.055) and glioblastoma multiforme (p = 0.046). The 5-year PFS rates for anaplastic astrocytoma were 44 \u00b1 11% and 22 \u00b1 6% for cases in which the tumor was radically resected and less than radically resected, respectively; whereas the 5-year PFS rates for glioblastoma multiforme were 26 \u00b1 9% and 4 \u00b1 3% for cases in which the tumor was radically resected and less than radically resected, respectively.<\/jats:p><jats:p content-type=\"fine-print\"><jats:italic>Conclusions.<\/jats:italic>The demonstration of a survival advantage provided by radical resection should prompt neurosurgeons to treat malignant pediatric astrocytomas with aggressive surgical resection prior to initiation of radiotherapy or adjuvant chemotherapy.<\/jats:p>","DOI":"10.3171\/jns.1998.89.1.0052","type":"journal-article","created":{"date-parts":[[2009,6,16]],"date-time":"2009-06-16T02:21:14Z","timestamp":1245118874000},"page":"52-59","source":"Crossref","is-referenced-by-count":254,"title":["Current neurosurgical management and the impact of the 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