Moiyadi Aliasgar V, Shetty Prakash
Neurosurgical Services, Department of Surgical Oncology, Tata Memorial Centre, Mumbai, India.
J Neurosurg Pediatr. 2012 Nov;10(5):411-7. doi: 10.3171/2012.8.PEDS12133. Epub 2012 Sep 7.
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.
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.
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).
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.
小儿脑肿瘤再次手术越来越被认可，切除范围是预后的重要预测指标。然而，再次手术可能会增加发病率。文献中很少有研究客观地提供此类结果。作者报告了他们在印度一家三级医疗神经肿瘤转诊中心进行再次手术的经验。
一个前瞻性维护的数据库记录了流行病学、临床、放射学、手术及围手术期事件。作者分析了117名18岁以下儿童，他们在5年期间接受了各种脑肿瘤切除手术。评估的终点包括术后即刻神经状态、出院时神经结局、局部并发症、全身并发症、总体发病率和死亡率。
大多数儿童（48%）年龄在3至10岁之间。颅内压升高（70%的患者）和神经功能缺损（60%的患者）是最常见的症状。相当一部分患者（35%）卡氏功能状态评分较差（≤70）。58%的患者进行了幕上手术。大多数患者（72%）有大肿瘤（>4cm）。58名患者（50%）曾接受过先前治疗，其中55名接受过手术。总体上，分别有27%、32%和25%的患者发生神经功能恶化、局部并发症和全身并发症。总体发病率为44.4%（严重发病率为26.5%），围手术期死亡率为7.7%。首次手术患者神经功能恶化更常见（p = 0.038），而伤口相关并发症在再次手术患者中更常见（p = 0.00）。
与成年患者相比，小儿患者肿瘤更大，且往往在先前治疗后表现出较差的功能状态。先前接受治疗的亚组伤口相关并发症较高；然而，神经并发症较少，可能是因为患者选择得当。尽管缺乏先进的术中辅助设备，但小儿脑肿瘤再次手术仍可实现可接受的总体发病率和死亡率。
