BACKGROUND Due to technical advancements and availability of neuroimaging, detection of incidental pediatric brain tumors (IPBT) is growing rapidly. The management of these asymptomatic lesions remains unclear; radiological, pathological, and clinical risk factors for further growth and malignant transformation (MT) are not well defined. METHODS We systematically reviewed the literature on the dilemmas and management of IPBT suggestive of a low-grade brain tumor (LGBT). Keyword searches of the PubMed and Medline (NCBI) databases identified studies on IPBT describing the prevalence, neuroimaging, management, or risk of MT through July 2019. References of the identified articles were also reviewed. RESULTS A total of 2021 records were screened. Fifty-nine full-text articles were reviewed, and 34 published studies were included. IPBT are diagnosed in 0.2-5.7% of children undergoing brain imaging for various reasons. The accepted approach for management of lesions showing radiological characteristics suggestive of LGBT is radiological follow-up. The rate at which additional intervention is required during follow-up for these apparently low-grade lesions is 9.5%. Nevertheless, the dilemma of early surgical resection or biopsy vs. clinical and radiological follow-up of IPBT is still unresolved. The risk in these cases is missing a transformation to a higher grade tumor. However, MT of pediatric LGBT is very rare, occurring in less than 3% of the cases of proven low-grade gliomas in children. The risk of future MT in pediatric low-grade gliomas seems to be greater in the presence of specific molecular markers such as BRAF V-600E, CDKN2A, and H3F3A K27M. CONCLUSIONS The natural history, management, and prognosis of IPBT remain ambiguous. It seems that lesions suggestive of LGBT can initially be followed, since many of these lesions remain stable over time and MT is rare. However, controversy among centers concerning the ideal approach still exists. Further observational and prospective cohort studies, focusing on potential clinical and radiological characteristics or risk factors suggestive of high-grade tumors, tumor progress, or MT of IPBT, are needed.

中文翻译：

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儿童偶发性脑肿瘤的治疗：系统评价。

背景技术由于技术的进步和神经影像学的可获得性，儿童小脑肿瘤的偶然发现（IPBT）正在迅速增长。这些无症状病变的治疗尚不清楚；进一步生长和恶性转化（MT）的放射学，病理学和临床危险因素尚不明确。方法我们系统地回顾了有关IPBT困境和治疗的文献，这些文献提示了低度脑肿瘤（LGBT）。对PubMed和Medline（NCBI）数据库的关键词搜索确定了IPBT研究，描述了直至2019年7月MT的患病率，神经影像学，管理或风险。还对已鉴定文​​章的参考文献进行了综述。结果筛选了2021条记录。评论了59篇全文文章，包括34篇已发表的研究。由于各种原因，在接受脑成像检查的儿童中，诊断为IPBT的儿童占0.2-5.7％。表现出提示LGBT的放射学特征的病变管理的公认方法是放射学随访。对于这些明显的低度病变，在随访期间需要额外干预的比率为9.5％。尽管如此，早期手术切除或活检与IPBT临床和放射学随访之间的矛盾仍未解决。这些情况下的风险是缺少向更高级别肿瘤的转化。然而，儿科LGBT的MT极为罕见，在儿童中已证实的低度神经胶质瘤病例中，发生率不到3％。在存在BRAF V-600E，CDKN2A和H3F3A K27M等特定分子标记的情况下，小儿低度神经胶质瘤未来发生MT的风险似乎更大。结论IPBT的自然病史，治疗和预后仍然不明确。似乎可以初步观察到提示LGBT的病变，因为这些病变中的许多随着时间推移都保持稳定，而MT很少见。但是，各中心之间仍存在关于理想方法的争议。需要进行进一步的观察性和前瞻性队列研究，重点是潜在的临床和放射学特征或提示高级别肿瘤，肿瘤进展或IPBT MT的危险因素。