Pediatric brain incidentalomas: management strategy and systematic review

INTRODUCTION. The extensive application of various neuroimaging technologies has led to the identification of a significant number of pediatric incidental brain findings with unclear prognostic factors. Some of these findings exhibit radiological features consistent with neoplastic processes, presenting considerable challenges in clinical management. AIM. This study aims to systematically review and assess current approaches to the management of pediatric patients with incidentally discovered brain lesions (incidentalomas). MATERIALS AND METHODS. A systematic review was conducted using the eLibrary, PubMed, and Medline (NCBI) databases. The search focused on studies involving incidentally discovered brain tumors (incidentalomas) in children. The literature was analyzed in terms of the frequency of incidentalomas, diagnostic methods, management strategies, and the risk of malignant transformation, up to August 2024. RESULTS. A total of 2,213 articles were reviewed, of which 78 were full-text articles. Ultimately, 42 articles were included in the final analysis. Incidentalomas of the brain were identified in 0.2 to 5.7 % of pediatric neuroimaging studies and were found to represent a heterogeneous group of lesions, with low-grade gliomas being the most commonly diagnosed. CONCLUSION. While most pediatric brain incidentalomas exhibit a relatively benign course, some may progress, with rare cases of malignant transformation observed. As such, careful and ongoing monitoring of patients with these incidental findings is warranted.