Perioperative problems in patients with brainstem tumors and their influence on patient outcome

Bharati, Sachidanand Jee; Pandia, Mihir Prakash; Rath, Girija Prasad; Bithal, Parmod K.; Dash, Hari H.; Dube, Surya Kumar

doi:10.4103/0970-9185.182102

Cited by 9 publications

(2 citation statements)

References 19 publications

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“…Infratentorial surgery is also associated with an increased likelihood of CSF leakage, leading to a higher incidence of postoperative meningitis 22,23 . Bharati et al 24 also report a correlation between postoperative complications and adverse neurological outcomes.…”

Section: Discussionmentioning

confidence: 93%

Clinical and Surgical Characteristics of Posterior Fossa Tumors in Adults – Single-Center Experience of Surgical Management

Janković

2023

ACC

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In contrast to tumors in children, between 6% and 20% of all brain tumors in adults arise solitary in the posterior cranial fossa. Given their rarity in adults, as well as the importance and complexity of their treatment, this paper reviews and discusses the clinical and surgical characteristics of such tumors. In a retrospective single-institution observational study, adult patients with posterior fossa tumors treated surgically over a ten-year period were analyzed. The characteristics observed were age and gender distribution, clinical symptoms, histopathologic tumor type, tumor size, location and extent of surgical resection, tumor recurrence and postoperative complications, as well as surgical outcome. Sixty-six patients who underwent surgical treatment were diagnosed with a tumor in the posterior fossa. The mean age was 63 years, and patients were evenly distributed by gender. The most common histopathologic type was metastatic tumor (59.1%), whereas meningioma was the most common primary brain tumor (16.6%) recorded. Most patients presented with vegetative and cerebellar symptoms in general and cranial nerve palsy, especially in the occurrence of vestibular schwannoma. In conclusion, posterior fossa tumors grow in a confined space and therefore may directly threaten vital centers in their immediate vicinity. Thus, it is crucial to schedule an appropriate surgical intervention as soon as possible, as it can significantly improve treatment outcome and prognosis of the disease. If possible, meticulous total tumor resection should be the treatment of choice. In the case of hydrocephalus, a ventriculoperitoneal shunt should be considered as an alternative surgical option after tumor resection.

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Section: Discussionmentioning

confidence: 93%

Clinical and Surgical Characteristics of Posterior Fossa Tumors in Adults – Single-Center Experience of Surgical Management

Janković

2023

ACC

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“…intraoperative hemodynamic instability and mechanical ventilator dependency) or mortality, even if the radical tumor excision of nondiffuse low-grade brainstem glioma is curative and radical excision of high-grade nondiffuse brainstem glioma results in better survival. [ 1 , 5 , 10 , 15 ]…”

Section: Discussionmentioning

confidence: 99%

Surgical considerations for maximal safe resection of exophytic brainstem glioma in the pediatric age group

Mahmoud

Enayet

Alselisly

2021

Surgical Neurology International

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Background: Brainstem glioma is the leading cause of morbidity and mortality among all central nervous system tumors, especially in childhood as it represents about 20% of all pediatric brain tumors. Therefore, this study aimed to present our experience in a tertiary center in a developing country with limited resources for the surgical management of exophytic brainstem gliomas. Methods: This retrospective study included pediatric patients with brainstem (midbrain, pontine, or medullary) focal or diffuse gliomas whether low or high grade that had dorsal, ventral, or lateral exophytic component who were presented to our hospitals from January 2019 to January 2021. The patients’ data were collected, such as age, sex, preoperative and postoperative clinical condition, radiological data, surgical approach, extent of tumor removal, histopathology, follow-up period, and adjuvant therapy. Results: A total of 23 patients were included in this study. The telovelar approach was used in 17 patients, the supracerebellar infratentorial approach in three patients, and the retrosigmoid, transcerebellar, and occipital transtentorial approach once for each patient. Twenty patients underwent near-total excision, and three underwent subtotal excision. Two-thirds of our cases (17 patients) were low-grade gliomas, with the remaining one-third comprising entirely of either anaplastic astrocytoma (five patients) or glioblastoma multiforme (one patient). The follow-up period of the patients extended from 3 months to 24 months. Conclusion: Exophytic brainstem glioma surgery can result in good outcomes with minimal complications when near-total excision is attempted through a properly chosen approach and adherence to some surgical techniques and considerations.

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Nationwide analysis of unplanned 30‐day readmissions after transsphenoidal pituitary surgery

Rizvi

Ferrandino

Luu

et al. 2018

Int Forum Allergy Rhinol

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Background:Transsphenoidal pituitary surgery has evolved into a safe procedure with shorter hospitalizations, yet unplanned readmissions remain a quality measure for which there is a paucity of data. We sought to examine rates, timing, etiologic factors, and costs surrounding readmission a er transsphenoidal pituitary surgery. Methods:The Nationwide Readmissions Database (NRD) was queried for patients who underwent transsphenoidal pituitary between January 2013 and November 2013. Patient, procedure, admission, and hospital-level characteristics were compared for patients with and without unplanned 30-day readmission. Multivariate logistic regression was used to identify readmission predictors. A total of 8546 patients were included in this retrospective study. Results:A total of 8546 patients with a median age of 54 years and female predominance were identified, with 742 patients experiencing at least 1 unplanned readmission within 30 days of index admission. Hypertension, hypothyroidism, diabetes, and obesity were common comorbidities among readmi ed patients. Readmission was most frequently because of nervous system complications, followed by neurohypophyseal or electrolyte disorders, cerebrospinal fluid leak, hemorrhage, and meningitis. Median length and cost of stay of index admission was greater in the readmission group (p < 0.001). Fluid and electrolyte disorders as well as neurologic disease (most commonly epilepsy or convulsions) present on initial admission were predictive of length of initial stay and readmission (p < 0.001). Median readmission cost was $7723 and was expected to occur within 7 days.Conclusion: Approximately 8.7% of patients undergoing transsphenoidal pituitary surgery experience an unplanned readmission within 30 days of discharge. Risk factors identified should be considered to reduce preventable readmissions and identify medically complex patients. C 2018 ARS-AAOA, LLC.

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Perioperative problems in patients with brainstem tumors and their influence on patient outcome

Cited by 9 publications

References 19 publications

Clinical and Surgical Characteristics of Posterior Fossa Tumors in Adults – Single-Center Experience of Surgical Management

Clinical and Surgical Characteristics of Posterior Fossa Tumors in Adults – Single-Center Experience of Surgical Management

Surgical considerations for maximal safe resection of exophytic brainstem glioma in the pediatric age group

Nationwide analysis of unplanned 30‐day readmissions after transsphenoidal pituitary surgery

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