Surgical morbidity and mortality of pediatric brain tumors: a single center audit

Abstract

ObjectivesThe primary aim of this study is to perform an internal quality control of pediatric brain tumor surgery in the neurosurgical department of the VU University Medical Center Amsterdam (The Netherlands). Secondly, this study aims to contribute to the accumulating data concerning outcome in pediatric neurosurgery, in order to establish institutional practice benchmarks.MethodsWe report the surgical mortality and morbidity of 121 patients (0–18 years) surgically treated for a brain tumor from January 1999 to August 2007. Patients, in whom only a brain tumor biopsy was performed, were excluded.ResultsMean age at first surgery was 8.2 years. Of the 121 patients, 14 had a second surgery, and two underwent a third surgery (for a total of 137 operations). Of all 121 primary surgeries, 66% were total resections, 26% subtotal resections, and 8% partial resections. The overall surgical morbidity rate in this study was 69% after first surgery, 50% after second surgery, and one out of two after third surgery.ConclusionThese overall morbidity rates are comparable to other published mixed case series. The surgical mortality rate was 0.8%; this is comparable to the lowest rates reported for high-volume neurosurgical centers. We encourage other neurosurgical centers to collect, analyze, and publish their data. These data can then serve as a basis for comparison with other pediatric neurosurgical centers and will eventually lead to an improvement of pediatric neurosurgical practice and patient care.

Does size matter? Minimally invasive approach in pediatric neurosurgery—a review of 125 minimally invasive surgeries in children: clinical history and operative results

“…One hundred fifteen of them harbored brain tumors. The frequencies of tumor entities, age of the patients at diagnosis, and clinical symptoms at initial presentation are comparable to other published series, which makes the outcome of our series applying minimally invasive techniques comparable [16,17].…”

“…Postsurgical neurological outcome was furthermore classified into three groups: 1=improved, 2=worsened, and 3=unchanged in neurological symptoms. Mortality associated to surgery was defined as death within 30 days postoperatively (17).…”

“…In recent years, several authors analyzed and discussed perioperative complications and mortality in their pediatric patients in general [22,30,35] and neuro-oncological patients in particular [16,17]. They report a surgical mortality after pediatric brain tumor surgery around or below 1 %.…”

Clinical characteristics and modality of surgical treatment of pediatric neuroepithelial tumors

“…There is no statistically difference in the age of patient in relation to tumor grade. These results are the same as in the literature (15)(16)(17)(18)(19)(20)(21).…”

“…This difference comes from the pathohistological characteristics of neuroepitehlial tumors, because radical surgical resection enables better results from adjuvant therapy (14)(15)(16)(17)(18)(19)(20). Other methods of surgical treatment included partial surgical resection and biopsy without a statistical difference regarding compartmental distribution.…”