Goethe Eric A, Gadgil Nisha, Stormes Katie, Wassef Audrey, LoPresti Melissa, Lam Sandi
Department of Neurosurgery, Division of Pediatric Neurosurgery, Texas Children's Hospital, Baylor College of Medicine, 6701 Fannin St., Ste. 1230, Houston, TX, 77030, USA.
Division of Pediatric Neurosurgery, Ann and Robert H Lurie Children's Hospital, Chicago, IL, 60611, USA.
Childs Nerv Syst. 2020 May;36(5):925-931. doi: 10.1007/s00381-019-04468-7. Epub 2020 Jan 3.
Posterior fossa tumors (PFTs) are the most common type of brain tumor in children. Dysphagia is a known complication of PFT resection in children, but data regarding risk factors and clinical course are sparse.
The records of all children who underwent resection of posterior fossa tumor between April 2007 and May 2017 at our institution were analyzed. Clinical, radiographic, histologic data were gathered. Swallowing function was assessed immediately postoperatively and at 1-year follow-up.
A total of 197 patients were included. Forty-three (21.8%) patients developed dysphagia after surgery. Patients who developed dysphagia were younger (4.5 vs. 7.2 years, p < 0.01), were more likely to have brainstem compression (74.4% vs. 57.8%, p < 0.03) or invasion (14.0 vs. 9.7%, p < 0.03), and were more likely to have ependymoma (27.9% vs. 13.6%, p < 0.01) or ATRT (atypical teratoid/rhabdoid tumor) (9.3% vs. 3.9%, p < 0.01). Patients with postoperative dysphagia also had a longer length of stay (33.7 vs. 12.7 days, p < 0.01) and were more likely to be discharged to inpatient rehabilitation (25.6% vs. 9.1%, p < 0.01). Ten patients (5.1%) were PEG-dependent by 1-year follow-up. These patients were younger (2.7 vs. 5.6 years, p < 0.01), had a longer length of stay (55.5 vs. 27.4 days, p < 0.01), and were more likely to have ATRT (30.0% vs. 0.0%, p < 0.01). Recovery was not associated with tumor grade or extent of resection.
Dysphagia after PFT resection is associated with younger age, aggressive tumor histology, and increased healthcare utilization. While most patients recover, a small percentage are still dependent on enteral feeding at 1-year follow-up. Further research is needed to identify factors associated with persistent deficits.
后颅窝肿瘤（PFTs）是儿童最常见的脑肿瘤类型。吞咽困难是儿童PFT切除术后已知的并发症，但关于危险因素和临床病程的数据较少。
分析了2007年4月至2017年5月在我院接受后颅窝肿瘤切除术的所有儿童的记录。收集了临床、影像学、组织学数据。术后立即和1年随访时评估吞咽功能。
共纳入197例患者。43例（21.8%）患者术后出现吞咽困难。出现吞咽困难的患者年龄较小（4.5岁对7.2岁，p<0.01），更有可能出现脑干受压（74.4%对57.8%，p<0.03）或侵犯（14.0对9.7%，p<0.03），更有可能患有室管膜瘤（27.9%对13.6%，p<0.01）或非典型畸胎样/横纹肌样肿瘤（ATRT）（9.3%对3.9%，p<0.01）。术后吞咽困难的患者住院时间也更长（33.7天对12.7天，p<0.01），更有可能出院到住院康复机构（25.6%对9.1%，p<0.01）。到1年随访时，10例患者（5.1%）依赖经皮内镜下胃造口术（PEG）。这些患者年龄较小（2.7岁对5.6岁，p<0.01），住院时间更长（55.5天对27.4天，p<0.01），更有可能患有ATRT（30.0%对0.0%，p<0.01）。恢复情况与肿瘤分级或切除范围无关。
PFT切除术后的吞咽困难与年龄较小、侵袭性肿瘤组织学以及医疗资源利用增加有关。虽然大多数患者康复，但在1年随访时有一小部分患者仍依赖肠内喂养。需要进一步研究以确定与持续功能障碍相关的因素。
