Del glioma intrínseco difuso de protuberancia al glioma difuso de línea media H3K27M-alterado: ¿cuál ha sido el papel de la biopsia estereotáctica?

Revista Argentina de Neurocirugia RANC; María Victoria  Becerra Castro; Mariana Alamar Abril; Diego Culebras Palau; Santiago Candela Cantó; Andrés Morales La Madrid; José Hinojosa Mena-Bernal

doi:10.59156/revista.v38i03.657

Revista Argentina de Neurocirugia RANC AANC https://orcid.org/0000-0002-1825-0097
María Victoria Becerra Castro Servicio de Neurocirugía, Hospital Sant Joan de Déu, Barcelona, España https://orcid.org/0009-0007-7205-3725
Mariana Alamar Abril Servicio de Neurocirugía, Hospital Sant Joan de Déu, Barcelona, España https://orcid.org/0000-0002-4942-1717
Diego Culebras Palau Servicio de Neurocirugía, Hospital Sant Joan de Déu, Barcelona, España https://orcid.org/0009-0007-2102-3323
Santiago Candela Cantó Servicio de Neurocirugía, Hospital Sant Joan de Déu. Barcelona, España https://orcid.org/0000-0002-7116-7727
Andrés Morales La Madrid Servicio de Oncología Pediátrica, Hospital Sant Joan de Déu, Barcelona, España https://orcid.org/0000-0001-7083-4316
José Hinojosa Mena-Bernal Servicio de Neurocirugía, Hospital Sant Joan de Déu, Barcelona, España https://orcid.org/0000-0003-2438-7679

DOI: https://doi.org/10.59156/revista.v38i03.657

Palabras clave: Biopsia estereotáxica, Glioma pontino intrínseco difuso, Glioma difuso de línea media H3K27M-alterada, H3K27M

Resumen

Introducción: la biopsia estereotáxica en el tumor difuso de protuberancia ha demostrado ser una técnica factible, con alta rentabilidad diagnóstica y baja morbilidad neurológica. Además, ha abierto las puertas a nuevos enfoques terapéuticos basados en la medicina individualizada y los ensayos clínicos, en una enfermedad en la que, actualmente, no existe tratamiento curativo y cuya supervivencia es completamente infausta. Sin embargo, durante años, el papel de este procedimiento quirúrgico en el manejo diagnóstico y terapéutico del paciente pediátrico con glioma pontino intrínseco difuso (GPID) ha sido cuestionado y controvertido.

Objetivos: realizar una revisión histórica sobre la percepción quirúrgica e indicación de la biopsia estereotáctica en el GPID, así como su contribución al conocimiento y comprensión de su compleja biología molecular y, consecuentemente, su repercusión en las nuevas terapias.

Material y métodos: se describen las características generales y de diagnóstico habitual del GPID. Posteriormente, se analizan las limitaciones y consecuencias del diagnóstico clásico, así como su repercusión en el tratamiento de este tipo de tumor.

Resultados: se realiza una viñeta histórica sobre el rol de la biopsia estereotáctica en los tumores de tronco y, en particular, en el GPID, junto con su repercusión en el conocimiento, su biología molecular y avances terapéuticos.

Conclusiones: la biopsia estereotáctica en el tumor difuso de protuberancia es un procedimiento factible con una baja morbi-mortalidad y alta rentabilidad diagnóstica: se aconseja llevarla a cabo en centros médicos experimentados de referencia en neuro-oncología pediátrica.

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