Neurosurgery Department, American university of Beirut Medical Center, Lebanon.
Faculty of Medecine, Beirut Arab University, Lebanon.
Clin Neurol Neurosurg. 2020 Oct;197:106170. doi: 10.1016/j.clineuro.2020.106170. Epub 2020 Aug 22.
Among all childhood cancers, brain tumors are second only to leukemia in incidence and are the most common solid pediatric tumors. More than 60 % of pediatric brain tumors are infra-tentorial. The first-line treatment for most infra-tentorial tumors in pediatric patients is surgical resection, with the goal of gross-total resection, relief of symptoms and hydrocephalus, and increased survival. The proximity to the fourth ventricle, and therefore, the cerebrospinal fluid (CSF) pathways, predisposes children with posterior fossa tumors to the development of obstructive hydrocephalus and multiple other co-morbidities pre and post-surgery.
This study aims to present our series of pediatric posterior fossa tumor surgeries in the Neurosurgical Department at the American University of Beirut Medical Center(AUBMC) and perform internal quality control for our single-institution consecutive series as one of the largest referral and tertiary care centers in the region. The second purpose of this retrospective study is to weigh the risks of surgery against the presumed advantages and to have specific knowledge about the complication rates, especially those related to the CSF pathway, comparing our results to those in the literature.
All pediatric patients (< 18 years of age), referred to our center from different regions in the middle east, and surgically treated for a posterior fossa tumor from June 2006 to June 2018 at the American University of Beirut Medical Center were included. A thorough review of all medical charts was performed to validate all the database records.
The patient sample consisted of 64 patients having a mean age of 6.19 ± 4.42 years and 59.37 % of whom were males. The most common tumor pathology was pilocytic astrocytoma (40.62 %) followed by medulloblastoma (35.93 %) and ependymoma. The most common type of tumor that was seen in patients that developed mutism postoperatively (n = 6, 9.37 %) was medulloblastoma (n = 4, 66.66 %). In this patient sample, 12.28 % (n = 7) of the patients developed hydrocephalus postoperatively.Midline tumors were more associated with the development of mutism(OR = 4.632, p = 0.306) and hydrocephalus (OR = 5.056, p = 0.135) postoperatively, albeit not statistically significantly.The presence of a preoperative shunt was shown to be protective against the development of CSF leak (OR = 0.636, p = 0.767), as none of the patients that came in with CSF diversion developed a CSF leak after their surgery.
This study from a single center experience accompanied by a thorough literature review sheds light on the complications frequently encountered after posterior fossa tumor surgery in children. These included transient cerebellar mutism, CSF leak, and hydrocephalus as seen in some of our patients. Our findings highlight the need for prospective studies with well-defined protocols directed at assessing novel ways and approaches to minimize the risk of these complications.
在所有儿童癌症中，脑肿瘤的发病率仅次于白血病，是最常见的小儿实体瘤。超过 60%的小儿脑肿瘤位于小脑幕下。小儿小脑幕下肿瘤的一线治疗方法是手术切除，目标是实现大体全切除，缓解症状和脑积水，并提高生存率。由于靠近第四脑室，因此靠近脑脊液（CSF）通路，使后颅窝肿瘤患儿容易发生梗阻性脑积水和手术前后的多种其他合并症。
本研究旨在展示我们在贝鲁特美国大学医学中心（AUBMC）神经外科进行的一系列小儿后颅窝肿瘤手术，并对我们单中心连续系列进行内部质量控制，作为该地区最大的转诊和三级护理中心之一。这项回顾性研究的第二个目的是权衡手术风险与假定的优势，并对并发症发生率，特别是与 CSF 通路相关的并发症发生率有具体的了解，将我们的结果与文献中的结果进行比较。
所有年龄小于 18 岁的小儿患者（<18 岁），从中东不同地区转诊至我们中心，并于 2006 年 6 月至 2018 年 6 月在 AUBMC 接受后颅窝肿瘤手术治疗，均纳入本研究。对所有病历进行了全面审查，以验证数据库记录的所有内容。
患者样本包括 64 名患者，平均年龄为 6.19±4.42 岁，其中 59.37%为男性。最常见的肿瘤病理学是毛细胞型星形细胞瘤（40.62%），其次是髓母细胞瘤（35.93%）和室管膜瘤。在术后出现缄默症的 6 名患者（9.37%）中，最常见的肿瘤类型是髓母细胞瘤（n=4，66.66%）。在这个患者样本中，12.28%（n=7）的患者术后出现脑积水。中线肿瘤与术后缄默症（OR=4.632，p=0.306）和脑积水（OR=5.056，p=0.135）的发生更相关，尽管没有统计学意义。术前分流术的存在被证明可以预防 CSF 漏（OR=0.636，p=0.767），因为没有一例接受 CSF 引流的患者在手术后发生 CSF 漏。
这项来自单中心的经验研究，并结合了全面的文献回顾，阐明了小儿后颅窝肿瘤手术后常发生的并发症。这些并发症包括一些患者出现的短暂小脑缄默症、CSF 漏和脑积水。我们的研究结果强调需要进行前瞻性研究，制定明确的方案，以评估降低这些并发症风险的新方法和途径。
