Reporting morbidity associated with pediatric brain tumor surgery: are the available scoring systems sufficient?

2021 ◽  
pp. 1-10
Author(s):  
Mitchell T. Foster ◽  
Dawn Hennigan ◽  
Rebecca Grayston ◽  
Kirsten van Baarsen ◽  
Geraint Sunderland ◽  
...  
Keyword(s):  
Brain Tumor ◽  
Mortality Rate ◽  
Surgical Complication ◽  
Pediatric Brain Tumor ◽  
Direct Result ◽  
Tumor Surgery ◽  
Brain Tumor Surgery ◽  
Surgical Morbidity ◽  
Pediatric Brain ◽  
Pediatric Neurooncology

OBJECTIVEComplications in pediatric neurooncology surgery are seldom and inconsistently reported. This study quantifies surgical morbidity after pediatric brain tumor surgery from the last decade in a single center, using existing morbidity and outcome measures.METHODSThe authors identified all pediatric patients undergoing surgery for an intracranial tumor in a single tertiary pediatric neurosurgery center between January 2008 and December 2018. Complications between postoperative days 0 and 30 that had been recorded prospectively were graded using appropriate existing morbidity scales, i.e., the Clavien-Dindo (CD), Landriel, and Drake scales. The result of surgery with respect to the predetermined surgical aim was also recorded.RESULTSThere were 477 cases (364 craniotomies and 113 biopsies) performed on 335 patients (188 males, median age 9 years). The overall 30-day mortality rate was 1.26% (n = 6), and no deaths were a direct result of surgical complication. Morbidity on the CD scale was 0 in 55.14%, 1 in 10.69%, 2 in 18.66%, 3A in 1.47%, 3B in 11.74%, and 4 in 1.05% of cases. Morbidity using the Drake classification was observed in 139 cases (29.14%). Neurological deficit that remained at 30 days was noted in 8.39%; 78% of the returns to the operative theater were for CSF diversion.CONCLUSIONSTo the authors’ knowledge, this is the largest series presenting outcomes and morbidity from pediatric brain tumor surgery. The mortality rate and morbidity on the Drake classification were comparable to those of published series. An improved tool to quantify morbidity from pediatric neurooncology surgery is necessary.

scholarly journals TRTH-02. STIMULATED RAMAN SCATTERING MICROSCOPY PROVIDES RAPID, DIAGNOSTIC HISTOPATHOLOGIC IMAGES DURING PEDIATRIC BRAIN TUMOR SURGERY

2017 ◽  
Vol 19 (suppl_4) ◽  
pp. iv51-iv51
Author(s):  
Todd Hollon ◽  
Mia Garrard ◽  
Jamaal Tarpeh ◽  
Balaji Pandian ◽  
Yashar Niknafs ◽  
...  
Keyword(s):  
Brain Tumor ◽  
Raman Scattering ◽  
Stimulated Raman Scattering ◽  
Pediatric Brain Tumor ◽  
Tumor Surgery ◽  
Brain Tumor Surgery ◽  
Pediatric Brain ◽  
Stimulated Raman

scholarly journals Recent technological advances in pediatric brain tumor surgery

CNS Oncology ◽  
2017 ◽  
Vol 6 (1) ◽  
pp. 71-82 ◽  
Author(s):  
Bassel Zebian ◽  
Francesco Vergani ◽  
José Pedro Lavrador ◽  
Soumya Mukherjee ◽  
William John Kitchen ◽  
...  
Keyword(s):  
Brain Tumor ◽  
Pediatric Brain Tumor ◽  
Tumor Surgery ◽  
Brain Tumor Surgery ◽  
Technological Advances ◽  
Pediatric Brain

Timing, Duration, and Severity of Hyponatremia Following Pediatric Brain Tumor Surgery*

2014 ◽  
Vol 15 (5) ◽  
pp. 456-463 ◽  
Author(s):  
Jennifer S. Belzer ◽  
Cydni N. Williams ◽  
Jay Riva-Cambrin ◽  
Angela P. Presson ◽  
Susan L. Bratton
Keyword(s):  
Brain Tumor ◽  
Pediatric Brain Tumor ◽  
Tumor Surgery ◽  
Brain Tumor Surgery ◽  
Pediatric Brain

scholarly journals NSRG-12. EXPERIENCE WITH THE INTRAOPERATIVE MAGNETIC RESONANCE IN PEDIATRIC BRAIN TUMOR SURGERY

2018 ◽  
Vol 20 (suppl_2) ◽  
pp. i147-i148
Author(s):  
Sonia Tejada ◽  
Shivaram Avula ◽  
Benedetta Pettorini ◽  
Conor Mallucci
Keyword(s):  
Brain Tumor ◽  
Magnetic Resonance ◽  
Pediatric Brain Tumor ◽  
Tumor Surgery ◽  
Brain Tumor Surgery ◽  
Pediatric Brain

scholarly journals EMBR-05. THE TENTATIVE APPLICATION OF EN BLOC CONCEPT IN THE PEDIATRIC BRAIN TUMOR: EXPERIENCE FROM A LARGE PEDIATRIC CENTER IN CHINA

2021 ◽  
Vol 23 (Supplement_1) ◽  
pp. i6-i6
Author(s):  
Liangliang Cao ◽  
Jie Ma
Keyword(s):  
Brain Tumor ◽  
Blood Loss ◽  
Medical Center ◽  
Pediatric Brain Tumor ◽  
Preoperative Imaging ◽  
Imaging Features ◽  
Tumor Surgery ◽  
Brain Tumor Surgery ◽  
En Bloc ◽  
Pediatric Brain

Abstract Background The less allowable blood loss and tolerance of intraoperative blood loss of children lead to the high rate of massive blood transfusion in the treatment of brain tumor. The surgical concepts of en bloc resection may contribute to the improvement of brain tumor resection. Objective To investigate the effects of en bloc concept on short outcomes of pediatric brain tumors and factors associated with the application of en bloc concept. Methods According to the surgical concept involved, the patients were divided into three subgroups-complete en bloc concept, partial en bloc concept and piecemeal concept. The matching-comparison (piecemeal group and en bloc group formed from the first two subgroups) was conducted based on age, tumor location, lesion volume, and pathological diagnosis to investigate effect of the en bloc concept on the short-term outcomes. Then the patient data after January 2018, when the en bloc concept was routinely integrated into brain tumor surgery in our medical center, were reviewed and analyzed to find out the predictors associated with the application of en bloc concept. Results In the en bloc group, the perioperative outcomes, including hospital stay (p=0.001), PICU stay (p=0.003), total blood loss(p=0.015), transfusion rate(p=0.005) and complication rate(p=0.039), were all significantly improved. The multinomial logistic regression analysis showed that tumor volume and imaging features, like bottom vessel, encasing nerve or pass-by vessel, finger-like attachment, ratio of “limited line” and ratio of “clear line” remained independent factors for the application of en bloc concept in our medical center. Conclusion This study supports the application of complete or partial en bloc concept in the pediatric brain tumor surgery referring to the preoperative imaging features, and compared with piecemeal concept, en bloc concept can improve the short outcomes without significant increases in neurological complication. Large series and Additional supportive evidence are still warranted.

Craniotomy for Resection of Pediatric Brain Tumors in the United States, 1988 to 2000: Effects of Provider Caseloads and Progressive Centralization and Specialization of Care

Neurosurgery ◽  
2004 ◽  
Vol 54 (3) ◽  
pp. 553-565 ◽  
Author(s):  
Edward R. Smith ◽  
William E. Butler ◽  
Fred G. Barker
Keyword(s):  
United States ◽  
Brain Tumor ◽  
Mortality Rate ◽  
Multivariate Analyses ◽  
Pediatric Brain Tumor ◽  
High Volume ◽  
The United States ◽  
Mortality Rates ◽  
Discharge Disposition ◽  
Pediatric Brain

Abstract OBJECTIVE Large provider caseloads are associated with better patient outcomes after many complex surgical procedures. Mortality rates for pediatric brain tumor surgery in various practice settings have not been described. We used a national hospital discharge database to study the volume-outcome relationship for craniotomy performed for pediatric brain tumor resection, as well as trends toward centralization and specialization. METHODS We conducted a cross sectional and longitudinal cohort study using Nationwide Inpatient Sample data for 1988 to 2000 (Agency for Healthcare Research and Quality, Rockville, MD). Multivariate analyses adjusted for age, sex, geographic region, admission type (emergency, urgent, or elective), tumor location, and malignancy. RESULTS We analyzed 4712 admissions (329 hospitals, 480 identified surgeons) for pediatric brain tumor craniotomy. The in-hospital mortality rate was 1.6% and decreased from 2.7% (in 1988–1990) to 1.2% (in 1997–2000) during the study period. On a per-patient basis, median annual caseloads were 11 for hospitals (range, 1–59 cases) and 6 for surgeons (range, 1–32 cases). In multivariate analyses, the mortality rate was significantly lower at high-volume hospitals than at low-volume hospitals (odds ratio, 0.52 for 10-fold larger caseload; 95% confidence interval, 0.28–0.94; P = 0.03). The mortality rate was 2.3% at the lowest-volume-quartile hospitals (4 or fewer admissions annually), compared with 1.4% at the highest-volume-quartile hospitals (more than 20 admissions annually). There was a trend toward lower mortality rates after surgery performed by high-volume surgeons (P = 0.16). Adverse hospital discharge disposition was less likely to be associated with high-volume hospitals (P < 0.001) and high-volume surgeons (P = 0.004). Length of stay and hospital charges were minimally related to hospital caseloads. Approximately 5% of United States hospitals performed pediatric brain tumor craniotomy during this period. The burden of care shifted toward large-caseload hospitals, teaching hospitals, and surgeons whose practices included predominantly pediatric patients, indicating progressive centralization and specialization. CONCLUSION Mortality and adverse discharge disposition rates for pediatric brain tumor craniotomy were lower when the procedure was performed at high-volume hospitals and by high-volume surgeons in the United States, from 1988 to 2000. There were trends toward lower mortality rates, greater centralization of surgery, and more specialization among surgeons during this period.

Intraoperative MRI-guided Resection in Pediatric Brain Tumor Surgery: A Meta-analysis of Extent of Resection and Safety Outcomes

2020 ◽  
Vol 82 (01) ◽  
pp. 064-074
Author(s):  
Johannes Wach ◽  
Mohammad Banat ◽  
Valeri Borger ◽  
Hartmut Vatter ◽  
Hannes Haberl ◽  
...  
Keyword(s):  
Brain Tumor ◽  
Meta Analysis ◽  
Pediatric Brain Tumor ◽  
Extent Of Resection ◽  
Low Grade ◽  
Brain Tumor Surgery ◽  
Glioma Surgery ◽  
Guided Surgery ◽  
The Mean ◽  
Pediatric Brain

Abstract Background The objective of this meta-analysis was to analyze the impact of intraoperative magnetic resonance imaging (iMRI) on pediatric brain tumor surgery with regard to the frequency of histopathologic entities, additional resections secondary to iMRI, rate of gross total resections (GTR) in glioma surgery, extent of resection (EoR) in supra- and infratentorial compartment, surgical site infections (SSIs), and neurologic outcome after surgery. Methods MEDLINE/PubMed Service was searched for the terms “intraoperative MRI,” “pediatric,” “brain,” “tumor,” “glioma,” and “surgery.” The review produced 126 potential publications; 11 fulfilled the inclusion criteria, including 584 patients treated with iMRI-guided resections. Studies reporting about patients <18 years, setup of iMRI, surgical workflow, and extent of resection of iMRI-guided glioma resections were included. Results IMRI-guided surgery is mainly used for pediatric low-grade gliomas. The mean rate of GTR in low- and high-grade gliomas was 78.5% (207/254; 95% confidence interval [CI]: 64.6–89.7, p < 0.001). The mean rate of GTR in iMRI-assisted low-grade glioma surgery was 74.3% (35/47; 95% CI: 61.1–85.5, p = 0.759). The rate of SSI in surgery assisted by iMRI was 1.6% (6/482; 95% CI: 0.7–2.9). New onset of transient postoperative neurologic deficits were observed in 37 (33.0%) of 112 patients. Conclusion IMRI-guided surgery seems to improve the EoR in pediatric glioma surgery. The rate of SSI and the frequency of new neurologic deficits after IMRI-guided surgery are within the normal range of pediatric neuro-oncologic surgery.

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