Feasibility of repeat surgery for pediatric brain tumors: an objective assessment of perioperative outcomes.

OBJECT: Repeat surgery for pediatric brain tumors is gaining acceptance, with extent of resection an important predictor of outcome. However, repeat surgeries may be associated with increased morbidity. Few studies in the literature provide such outcomes objectively. The authors report on their experience with repeat surgery at a tertiary care neurooncology referral center in India.

METHODS

A prospectively maintained database documented epidemiological, clinical, radiological, operative, and perioperative events. The authors analyzed 117 children (younger than 18 years of age) who had undergone various resective surgeries for brain tumors over a period of 5 years. Assessed end points included immediate postoperative neurological status, neurological outcome at discharge, regional complications, systemic complications, overall morbidity, and mortality.

RESULTS

The majority of children (48%) were between 3 and 10 years of age. Elevated intracranial pressure (70% of patients) and neurological deficits (60% of patients) were the commonest presenting symptoms. A significant proportion of patients (35%) had a poor Karnofsky Performance Scale score (≤ 70). Supratentorial procedures were performed in 58% of the patients. Most patients (72%) had large (> 4 cm) tumors. Fifty-eight patients (50%) had received prior treatment, surgery in 55. Neurological morbidity (worsening), regional complications, and systemic complications occurred in 27%, 32%, and 25% of patients overall, respectively. Overall morbidity was 44.4% (26.5% major), and perioperative mortality was 7.7%. Neurological worsening occurred more frequently in patients undergoing a first surgery (p = 0.038), whereas wound-related complications were more common in those undergoing reoperations (p = 0.00).

CONCLUSIONS

Pediatric patients had larger tumors and were more likely to present with a poor performance status, often after prior treatment, than their adult counterparts. Wound-related complications were higher in the previously treated subgroup; however, neurological complications were fewer, probably because of a favorable selection of patients. Despite the unavailability of advanced intraoperative aids, acceptable levels of overall morbidity and mortality could be achieved in repeat surgeries for pediatric brain tumors.