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Long-Term Neurological and Neurosurgical Outcomes After Surgery Only in Children with Low-Grade Brain Tumors

Liliana Goumnerova, Dan Drzymalski, Mark Kieran, Scott Pomeroy, R. Michael Scott, and Nancy Tarbell

Introduction

Brain tumors are the most common solid tumors of childhood. As treatment options such as surgery, chemotherapy, and radiotherapy improve, and affected children's survival increases, the focus has shifted toward understanding long-term outcomes. We hypothesized that tumor recurrence and long-term neurological outcomes can be correlated with age at diagnosis, site and size of tumor, histology, extent of surgery, and presence or absence of hydrocephalus. Thus, the aims of this study were to determine predictive factors for tumor recurrence and long-term morbidity in children who undergo surgery only for low-grade brain tumors. The study was approved by the institutional review board.

Methods

Medical records were reviewed for each child and information collected regarding sex, age at surgery, histology site, size of tumor, presence of hydrocephalus, extent of surgery, and date of tumor recurrence. Preoperative, postoperative, and last follow-up neurological exams were reviewed and patients were evaluated for ataxia, hemiparesis, impaired vision, cranial nerve deficits, presence of seizures or headaches, dysmetria, nystagmus, and depression.

Results

Forty-nine children (29 male, 20 female) ranging from 2.2 to 16.9 years of age at first operation were included; 31% had recurrence/progression. This was significantly correlated with tumors that were subtotally resected (p = 0.002) located in the supratentorial region (p = 0.017) and not astrocytoma or craniopharyngioma (p = 0.041). At last follow-up, 42% of children had no neurological sequelae, 53% had mild neurological sequelae, and 5% had moderate neurological sequelae. No children had experienced depression before or immediately after their initial surgery. However, 6 patients (16% of 38 patients) had depression at long-term follow-up.

Conclusion

These data indicate that we may be able to predict recurrence/progression of low-grade brain tumors based on extent of surgery location and histology. We also see that more than half of these children will experience a variety of surgical and neurological burdens throughout their lives.