Reporting morbidity associated with pediatric brain tumor surgery: are the available scoring systems sufficient?

Abstract

OBJECTIVEComplications in pediatric neurooncology surgery are seldom and inconsistently reported. This study quantifies surgical morbidity after pediatric brain tumor surgery from the last decade in a single center, using existing morbidity and outcome measures.METHODSThe authors identified all pediatric patients undergoing surgery for an intracranial tumor in a single tertiary pediatric neurosurgery center between January 2008 and December 2018. Complications between postoperative days 0 and 30 that had been recorded prospectively were graded using appropriate existing morbidity scales, i.e., the Clavien-Dindo (CD), Landriel, and Drake scales. The result of surgery with respect to the predetermined surgical aim was also recorded.RESULTSThere were 477 cases (364 craniotomies and 113 biopsies) performed on 335 patients (188 males, median age 9 years). The overall 30-day mortality rate was 1.26% (n = 6), and no deaths were a direct result of surgical complication. Morbidity on the CD scale was 0 in 55.14%, 1 in 10.69%, 2 in 18.66%, 3A in 1.47%, 3B in 11.74%, and 4 in 1.05% of cases. Morbidity using the Drake classification was observed in 139 cases (29.14%). Neurological deficit that remained at 30 days was noted in 8.39%; 78% of the returns to the operative theater were for CSF diversion.CONCLUSIONSTo the authors’ knowledge, this is the largest series presenting outcomes and morbidity from pediatric brain tumor surgery. The mortality rate and morbidity on the Drake classification were comparable to those of published series. An improved tool to quantify morbidity from pediatric neurooncology surgery is necessary.

The impact of 1.5-T intraoperative magnetic resonance imaging in pediatric tumor surgery: Safety, utility, and challenges

“…Among the infectious complications, only Escherichia coli meningitis occurred after CSF fistula in the immediate postoperative period. These data are within the reported 0%–2.5% risk cited in other pediatric ioMRI imaging series ( 15 , 26 , 29 , 32 , 38 – 41 ), which did not differ from others in which ioMRI was not used ( 42 , 43 ). Regarding safety, the high-strength magnetic field generates a complex and hazardous environment; mitigation of risks related to accidents caused by ferromagnetic instruments in order to guarantee the safety of both the patient and the staff could be carried out by applying a strict safety checklist, as other groups have also reported ( 4 – 6 ).…”

Neurosurgical morbidity in pediatric supratentorial midline low‐grade glioma: Results from the German LGG studies

“…By definition adverse events, complications and related new impairments, included all deviations from the regular postoperative course. We classified all adverse events according to the Drake classification, 25 a relevant morbidity measure in pediatric neurosurgery 32 . In addition to the Drake classification, we recorded increase of pre‐existing deficits, 30 days persistence of a newly developed neurological deficit, and newly developed neuroendocrine impairment with regard to the respective neurosurgical procedure, that is, tumor resection, biopsy or other interventions.…”

Neurosurgical morbidity in pediatric supratentorial midline low-grade glioma: Results from the German LGG studies.

“…We classified all adverse events according to the Drake classification, 25 a relevant morbidity measure in pediatric neurosurgery. 32 In addition to the Drake classification, we recorded increase of pre-existing deficits, 30 days persistence of a newly developed neurological deficit, and newly developed neuroendocrine impairment with regard to the respective neurosurgical procedure, that is, tumor resection, biopsy or other interventions.…”