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

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  • 1 Department of Paediatric Neurosurgery, Alder Hey Children’s NHS Foundation Trust, Liverpool;
  • 2 Department of Neurosurgery, Walton Centre NHS Foundation Trust, Liverpool;
  • 3 Cancer Research UK Brain Tumour Centre of Excellence, The University of Edinburgh;
  • 4 Department of Paediatric Neurosurgery, Royal Manchester Children’s Hospital, Manchester; and
  • 5 Department of Paediatric Oncology, Alder Hey Children’s NHS Foundation Trust, Liverpool, United Kingdom
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OBJECTIVE

Complications 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.

METHODS

The 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.

RESULTS

There 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.

CONCLUSIONS

To 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.

ABBREVIATIONS CD = Clavien-Dindo; CPA = cerebellopontine angle; EVD = external ventricular drain; ioMRI = intraoperative MRI.

Supplementary Materials

    • Supplementary Table and Figures (PDF 768 KB)

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Contributor Notes

Correspondence Conor Mallucci: Alder Hey Children’s NHS Foundation Trust, Liverpool, United Kingdom. conor.mallucci@alderhey.nhs.uk.

INCLUDE WHEN CITING Published online February 26, 2021; DOI: 10.3171/2020.9.PEDS20556.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

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