Predictors of postoperative complications and functional outcomes in pediatric patients with surgically treated fourth ventricle tumors.
Cerebellar mutism
Childhood tumor
Fourth ventricle tumors
Overall survival
Postoperative complications
Journal
Acta neurochirurgica
ISSN: 0942-0940
Titre abrégé: Acta Neurochir (Wien)
Pays: Austria
ID NLM: 0151000
Informations de publication
Date de publication:
03 Aug 2023
03 Aug 2023
Historique:
received:
07
04
2023
accepted:
11
07
2023
medline:
3
8
2023
pubmed:
3
8
2023
entrez:
3
8
2023
Statut:
aheadofprint
Résumé
Tumors of the fourth ventricle are frequently treated pathologies in pediatric neurosurgery. Data regarding predictors for permanent neurological deficits, long-term functional outcomes, cerebellar mutism (CM), the extent of resection (EOR), and oncological outcomes are scarce. We attempt to contribute to this topic with an analysis of our institutional cohort. A retrospective single-center study of patients aged ≤ 19 years who underwent primary surgical resection of a fourth ventricular tumor over a 15-year period (2006-2021). Predictors analyzed included age, gender, surgical approach, anatomical pattern, tumor grade, EOR, tumor volume, and others as appropriate. One hundred six patients were included (64 males, mean age 7.3 years). The rate of permanent neurological deficit was 24.2%; lateral tumor extension (p = 0.036) and tumor volume greater than 38 cm The overall rate of postoperative complications remains high due to the eloquent localization. Older patients (> 7 years) have been found to have better outcomes and prognosis. Achieving GTR whenever feasible and safe has been shown to be critical for tumor recurrence. CM was more common in patients with medulloblastoma and in patients with tumors extending through the foramen of Luschka. The telovelar approach uses a safe and anatomically sparing corridor; however, it has not been associated with a lower incidence of CM and neurological sequelae in our series, showing that each case should be assessed on an individual basis.
Sections du résumé
BACKGROUND
BACKGROUND
Tumors of the fourth ventricle are frequently treated pathologies in pediatric neurosurgery. Data regarding predictors for permanent neurological deficits, long-term functional outcomes, cerebellar mutism (CM), the extent of resection (EOR), and oncological outcomes are scarce. We attempt to contribute to this topic with an analysis of our institutional cohort.
METHODS
METHODS
A retrospective single-center study of patients aged ≤ 19 years who underwent primary surgical resection of a fourth ventricular tumor over a 15-year period (2006-2021). Predictors analyzed included age, gender, surgical approach, anatomical pattern, tumor grade, EOR, tumor volume, and others as appropriate.
RESULTS
RESULTS
One hundred six patients were included (64 males, mean age 7.3 years). The rate of permanent neurological deficit was 24.2%; lateral tumor extension (p = 0.036) and tumor volume greater than 38 cm
CONCLUSION
CONCLUSIONS
The overall rate of postoperative complications remains high due to the eloquent localization. Older patients (> 7 years) have been found to have better outcomes and prognosis. Achieving GTR whenever feasible and safe has been shown to be critical for tumor recurrence. CM was more common in patients with medulloblastoma and in patients with tumors extending through the foramen of Luschka. The telovelar approach uses a safe and anatomically sparing corridor; however, it has not been associated with a lower incidence of CM and neurological sequelae in our series, showing that each case should be assessed on an individual basis.
Identifiants
pubmed: 37535206
doi: 10.1007/s00701-023-05729-w
pii: 10.1007/s00701-023-05729-w
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Subventions
Organisme : Ministerstvo Zdravotnictví Ceské Republiky
ID : NU23-08-00460
Informations de copyright
© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Austria, part of Springer Nature.
Références
Ashida R, Nazar N, Edwards R, Teo M (2021) Cerebellar mutism syndrome: an overview of the pathophysiology in relation to the cerebrocerebellar anatomy, risk factors, potential treatments, and outcomes. World Neurosurg 153:63–74. https://doi.org/10.1016/j.wneu.2021.06.065
doi: 10.1016/j.wneu.2021.06.065
pubmed: 34157457
Atallah A, Rady MR, Kamal HM, El-Mansy N, Alsawy MFM, Hegazy A, Zaghloul M (2019) Telovelar approach to pediatric fourth ventricle tumors: feasibility and outcome. Turk Neurosurg 29:497–505. https://doi.org/10.5137/1019-5149.Jtn.24078-18.3
doi: 10.5137/1019-5149.Jtn.24078-18.3
pubmed: 30649815
Beneš V, Zápotocký M, Libý P, Táborský J, Blažková J, Blažková J, Sumerauer D, Mišove A, Perníková I, Kynčl M et al (2022) Survival and functional outcomes in paediatric thalamic and thalamopeduncular low grade gliomas. Acta Neurochir 164:1459–1472. https://doi.org/10.1007/s00701-021-05106-5
doi: 10.1007/s00701-021-05106-5
pubmed: 35043265
Catsman-Berrevoets CE, Van Dongen HR, Mulder PGH, Y Geuze DP, Paquier PF, Lequin MH (1999) Tumour type and size are high risk factors for the syndrome of “cerebellar” mutism and subsequent dysarthria. J Neurol Neurosurg Psychiatry 67:755–757. https://doi.org/10.1136/jnnp.67.6.755
doi: 10.1136/jnnp.67.6.755
pubmed: 10567492
Dandy WE (1932) The practice of surgery. The Brain. Hagerstwon, MD: WF Prior 12
Duffner PK, Horowitz ME, Krischer JP, Friedman HS, Burger PC, Cohen ME, Sanford RA, Mulhern RK, James HE, Freeman CR et al (1993) Postoperative chemotherapy and delayed radiation in children less than three years of age with malignant brain tumors. N Engl J Med 328:1725–1731. https://doi.org/10.1056/nejm199306173282401
doi: 10.1056/nejm199306173282401
pubmed: 8388548
Eissa E (2017) The role of telovelar approach in fourth ventricular surgery: a new perspective. Turk Neurosurg. https://doi.org/10.5137/1019-5149.jtn.21209-17.1
doi: 10.5137/1019-5149.jtn.21209-17.1
El-Bahy K (2005) Telovelar approach to the fourth ventricle: operative findings and results in 16 cases. Acta Neurochir 147:137–142. https://doi.org/10.1007/s00701-004-0407-0
doi: 10.1007/s00701-004-0407-0
pubmed: 15605202
Fabozzi F, Margoni S, Andreozzi B, Musci MS, Del Baldo G, Boccuto L, Mastronuzzi A, Carai A (2022) Cerebellar mutism syndrome: from pathophysiology to rehabilitation. Front Cell Dev Biol 10:1082947. https://doi.org/10.3389/fcell.2022.1082947
doi: 10.3389/fcell.2022.1082947
pubmed: 36531947
pmcid: 9755514
Ferguson SD, Levine NB, Suki D, Tsung AJ, Lang FF, Sawaya R, Weinberg JS, McCutcheon IE (2018) The surgical treatment of tumors of the fourth ventricle: a single-institution experience. J Neurosurg 128:339–351. https://doi.org/10.3171/2016.11.jns161167
doi: 10.3171/2016.11.jns161167
pubmed: 28409732
Grønbæk JK, Wibroe M, Toescu S, Frič R, Thomsen BL, Møller LN, Grillner P, Gustavsson B, Mallucci C, Aquilina K et al (2021) Postoperative speech impairment and surgical approach to posterior fossa tumours in children: a prospective European multicentre cohort study. Lancet Child Adolesc Health 5:814–824. https://doi.org/10.1016/s2352-4642(21)00274-1
doi: 10.1016/s2352-4642(21)00274-1
pubmed: 34624241
Gudrunardottir T, Morgan AT, Lux AL, Walker DA, Walsh KS, Wells EM, Wisoff JH, Juhler M, Schmahmann JD, Keating RF et al (2016) Consensus paper on post-operative pediatric cerebellar mutism syndrome: the Iceland Delphi results. Child’s Nerv Syst 32:1195–1203. https://doi.org/10.1007/s00381-016-3093-3
doi: 10.1007/s00381-016-3093-3
Jabarkheel R, Amayiri N, Yecies D, Huang Y, Toescu S, Nobre L, Mabbott DJ, Sudhakar SV, Malik P, Laughlin S et al (2020) Molecular correlates of cerebellar mutism syndrome in medulloblastoma. Neuro Oncol 22:290–297. https://doi.org/10.1093/neuonc/noz158
doi: 10.1093/neuonc/noz158
pubmed: 31504816
Jaju A, Yeom KW, Ryan ME (2022) MR imaging of pediatric brain tumors. Diagnostics 12:961. https://doi.org/10.3390/diagnostics12040961
doi: 10.3390/diagnostics12040961
pubmed: 35454009
pmcid: 9029699
Jiang T, Zhang Y, Wang J, Du J, Ma Z, Li C, Liu R, Zhang Y (2016) Impact of tumor location and fourth ventricle infiltration in medulloblastoma. Acta Neurochir 158:1187–1195. https://doi.org/10.1007/s00701-016-2779-3
doi: 10.1007/s00701-016-2779-3
pubmed: 27106847
Kellogg JX, Piatt JH Jr (1997) Resection of fourth ventricle tumors without splitting the vermis: the cerebellomedullary fissure approach. Pediatr Neurosurg 27:28–33. https://doi.org/10.1159/000121221
doi: 10.1159/000121221
pubmed: 9486833
Kothari RU, Brott T, Broderick JP, Barsan WG, Sauerbeck LR, Zuccarello M, Khoury J (1996) The ABCs of measuring intracerebral hemorrhage volumes. Stroke 27:1304–1305. https://doi.org/10.1161/01.str.27.8.1304
doi: 10.1161/01.str.27.8.1304
pubmed: 8711791
Lansky SB, List MA, Lansky LL, Ritter-Sterr C, Miller DR (1987) The measurement of performance in childhood cancer patients. Cancer 60:1651–1656. https://doi.org/10.1002/1097-0142
doi: 10.1002/1097-0142
pubmed: 3621134
Louis DN, Wesseling P, Aldape K, Brat DJ, Capper D, Cree IA, Eberhart C, Figarella-Branger D, Fouladi M, Fuller GN et al (2020) cIMPACT-NOW update 6: new entity and diagnostic principle recommendations of the cIMPACT-Utrecht meeting on future CNS tumor classification and grading. Brain Pathol 30:844–856. https://doi.org/10.1111/bpa.12832
doi: 10.1111/bpa.12832
pubmed: 32307792
pmcid: 8018152
Louis DN, Perry A, Wesseling P, Brat DJ, Cree IA, Figarella-Branger D, Hawkins C, Ng HK, Pfister SM, Reifenberger G et al (2021) The 2021 WHO classification of tumors of the central nervous system: a summary. Neuro Oncol 23:1231–1251. https://doi.org/10.1093/neuonc/noab106
doi: 10.1093/neuonc/noab106
pubmed: 34185076
pmcid: 8328013
Maloumeh EN, Khoshnoud RJ, Ebrahimzadeh K, Tavassol HH, Salari S, Mousavinejad A, Kargari A, Samadian M, Rezaei O (2021) Surgical management of the fourth ventricular tumors using telovelar approach and the role of neuroendoscopy: post-operative outcome and long-term results in a series of 52 cases. Clin Neurol Neurosurg 201:106419. https://doi.org/10.1016/j.clineuro.2020.106419
doi: 10.1016/j.clineuro.2020.106419
pubmed: 33340840
Mariën P, De Smet HJ, Wijgerde E, Verhoeven J, Crols R, De Deyn PP (2013) Posterior fossa syndrome in adults: a new case and comprehensive survey of the literature. Cortex 49:284–300. https://doi.org/10.1016/j.cortex.2011.06.018
doi: 10.1016/j.cortex.2011.06.018
pubmed: 21855865
Matsushima T, Rhoton AL Jr, Lenkey C (1982) Microsurgery of the fourth ventricle: part 1. Microsurgical anatomy. Neurosurgery 11:631–667. https://doi.org/10.1227/00006123-198211000-00008
doi: 10.1227/00006123-198211000-00008
pubmed: 7155330
Morris EB, Phillips NS, Laningham FH, Patay Z, Gajjar A, Wallace D, Boop F, Sanford R, Ness KK, Ogg RJ (2009) Proximal dentatothalamocortical tract involvement in posterior fossa syndrome. Brain 132:3087–3095. https://doi.org/10.1093/brain/awp241
doi: 10.1093/brain/awp241
pubmed: 19805491
pmcid: 2781745
Morrissy AS, Cavalli FMG, Remke M, Ramaswamy V, Shih DJH, Holgado BL, Farooq H, Donovan LK, Garzia L, Agnihotri S et al (2017) Spatial heterogeneity in medulloblastoma. Nat Genet 49:780–788. https://doi.org/10.1038/ng.3838
doi: 10.1038/ng.3838
pubmed: 28394352
pmcid: 5553617
Northcott PA, Korshunov A, Witt H, Hielscher T, Eberhart CG, Mack S, Bouffet E, Clifford SC, Hawkins CE, French P et al (2011) Medulloblastoma comprises four distinct molecular variants. J Clin Oncol 29:1408–1414. https://doi.org/10.1200/jco.2009.27.4324
doi: 10.1200/jco.2009.27.4324
pubmed: 20823417
Onorini N, Spennato P, Orlando V, Savoia F, Calì C, Russo C, De Martino L, de Santi MS, Mirone G, Ruggiero C et al (2022) The clinical and prognostic impact of the choice of surgical approach to fourth ventricular tumors in a single-center, single-surgeon cohort of 92 consecutive pediatric patients. Front Oncol 12:821738. https://doi.org/10.3389/fonc.2022.821738
doi: 10.3389/fonc.2022.821738
pubmed: 35280797
pmcid: 8912940
Pettersson SD, Kitlinski M, Miękisiak G, Ali S, Krakowiak M, Szmuda T (2022) Risk factors for postoperative cerebellar mutism syndrome in pediatric patients: a systematic review and meta-analysis. J Neurosurg: Pediatr 29:467–475. https://doi.org/10.3171/2021.11.peds21445
doi: 10.3171/2021.11.peds21445
pubmed: 34972081
Pols SYCV, Van Veelen MLC, Aarsen FK, Gonzalez Candel A, Catsman-Berrevoets CE (2017) Risk factors for development of postoperative cerebellar mutism syndrome in children after medulloblastoma surgery. J Neurosurg: Pediatr 20:35–41. https://doi.org/10.3171/2017.2.peds16605
doi: 10.3171/2017.2.peds16605
pubmed: 28498095
Rajesh BJ, Rao BRM, Menon G, Abraham M, Easwer HV, Nair S (2007) Telovelar approach: technical issues for large fourth ventricle tumors. Child’s Nerv Syst 23:555–558. https://doi.org/10.1007/s00381-006-0295-0
doi: 10.1007/s00381-006-0295-0
Resende LL, Alves CSAPF (2021) Imaging of brain tumors in children: the basics—a narrative review. Transl Pediatr 10:1138–1168. https://doi.org/10.21037/tp-20-285
doi: 10.21037/tp-20-285
pubmed: 34012860
pmcid: 8107871
Tamburrini G, Frassanito P, Chieffo D, Massimi L, Caldarelli M, Di Rocco C (2015) Cerebellar mutism. Child’s Nerv Syst 31:1841–1851. https://doi.org/10.1007/s00381-015-2803-6
doi: 10.1007/s00381-015-2803-6
Thomale UW, Driever PH (2013) Inconsistent terminology for cerebellar mutism. Childs Nerv Syst 29:717–718. https://doi.org/10.1007/s00381-013-2074-z
doi: 10.1007/s00381-013-2074-z
pubmed: 23503612
Toescu SM, Samarth G, Layard Horsfall H, Issitt R, Margetts B, Phipps KP, Jeelani NU, Thompson DNP, Aquilina K (2020) Fourth ventricle tumors in children: complications and influence of surgical approach. J Neurosurg Pediatr 27:52–61. https://doi.org/10.3171/2020.6.Peds2089
doi: 10.3171/2020.6.Peds2089
pubmed: 33096529
Tomasello F, Conti A, Cardali S, La Torre D, Angileri FF (2015) Telovelar approach to fourth ventricle tumors: highlights and limitations. World Neurosurg 83:1141–1147. https://doi.org/10.1016/j.wneu.2015.01.039
doi: 10.1016/j.wneu.2015.01.039
pubmed: 25698525
Yang W, Cai Y, Chen J, Yang P, Ying Z, Liang Y, Ling M, Zhu K, Sun H, Ji Y et al (2023) Epidemiological characteristics, clinical presentations, and prognoses of pediatric brain tumors: experiences of national center for children’s health. Front Oncol 13:1067858. https://doi.org/10.3389/fonc.2023.1067858
doi: 10.3389/fonc.2023.1067858
pubmed: 36776329
pmcid: 9915562
Yaşargil MG, Abdulrauf SI (2008) Surgery of intraventricular tumors. Neurosurgery 62:1029–1040. https://doi.org/10.1227/01.neu.0000333768.12951.9a . (discussion 1040–1021)
doi: 10.1227/01.neu.0000333768.12951.9a
pubmed: 18695523
Zaheer SN, Wood M (2010) Experiences with the telovelar approach to fourth ventricular tumors in children. Pediatr Neurosurg 46:340–343. https://doi.org/10.1159/000321539
doi: 10.1159/000321539
pubmed: 21346396