Wu Jennifer, Wishart Brian D, Cohen Stephanie E, Orme Patricia, Quinn Susan S, Nimec Donna
Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts, USA.
Division of Pediatric Rehabilitation Medicine, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Neuro Oncol. 2025 Feb 10;27(2):508-516. doi: 10.1093/neuonc/noae199.
Clinical recognition of the postoperative neurologic sequelae of posterior fossa tumors is inconsistent. This study aimed to characterize functional impairments and recovery trajectories in pediatric patients admitted to inpatient rehabilitation following surgical resection of posterior fossa brain tumors. This study also introduces the Pediatric Physiatric Posterior Fossa Symptom scale (3PFSs) for serial assessment of postoperative symptoms in pediatric posterior fossa brain tumors.
This retrospective cohort study included 49 patients aged 1.1 to 19.9 years admitted to a pediatric unit of a free-standing rehabilitation hospital following resection of a posterior fossa brain tumor. Functional Independence Measure for Children (WeeFIM) and 3PFSs scores at admission and discharge were the primary outcome measures.
Across the group, WeeFIM score improved from 51.5 ± 23.5 points at admission to 74.2 ± 28.2 points at discharge (t = 4.34, P < .001). The 3PFSs score also showed improvement from 10 [Interquartile range (IQR) = 9-12] points at admission to 8 [7-10] points at discharge (t = 9.3, P < .0001). While change in both the WeeFIM and 3PFSs captured statistically significant improvement in function, there was low interrating correlation (P > .7). In addition, mortality was correlated with a higher discharge 3PFSs score (P = .007) but not discharge WeeFIM score.
In pediatric patients with postoperative neurologic sequelae due to posterior fossa brain tumors, inpatient rehabilitation resulted in global and domain-specific functional improvements. This initial application of the 3PFSs demonstrates potential applicability for stratifying patients to appropriate levels of rehabilitation, capturing functionally relevant response to rehabilitation treatment, and prognosticating long-term outcomes. These initial results are promising but require additional validation in a larger cohort.
后颅窝肿瘤术后神经后遗症的临床识别并不一致。本研究旨在描述后颅窝脑肿瘤手术切除后入住住院康复机构的儿科患者的功能障碍及恢复轨迹。本研究还引入了儿科后颅窝症状量表（3PFSs），用于对儿科后颅窝脑肿瘤术后症状进行系列评估。
这项回顾性队列研究纳入了49例年龄在1.1至19.9岁之间的患者，这些患者在切除后颅窝脑肿瘤后入住一家独立康复医院的儿科病房。入院和出院时的儿童功能独立性测量量表（WeeFIM）和3PFSs评分是主要结局指标。
在整个研究组中，WeeFIM评分从入院时的51.5±23.5分提高到出院时的74.2±28.2分（t = 4.34，P <.001）。3PFSs评分也从入院时的10分[四分位间距（IQR）= 9 - 12]提高到出院时的8分[7 - 10]（t = 9.3，P <.0001）。虽然WeeFIM和3PFSs的变化均显示功能有统计学意义的改善，但评分者间相关性较低（P >.7）。此外，死亡率与出院时较高的3PFSs评分相关（P =.007），但与出院时的WeeFIM评分无关。
对于因后颅窝脑肿瘤导致术后神经后遗症的儿科患者，住院康复可带来整体和特定领域的功能改善。3PFSs的这一初步应用表明，其在将患者分层至适当的康复水平、捕捉与功能相关的康复治疗反应以及预测长期结局方面具有潜在适用性。这些初步结果很有前景，但需要在更大的队列中进行进一步验证。
