Retrospective analyses of pediatric posterior fossa tumors- clinical experience

Year 2022, , 656 - 660, 01.10.2022

Duygu Baykal , M Özgür Taşkapılıoğlu

https://doi.org/10.31362/patd.1064329

Abstract

Purpose: In this study, we aim to retrospectively evaluate surgical treatment of pediatric posterior fossa tumors in a tertiary university hospital.
Materials and methods: The files of pediatric patients who were operated for posterior fossa tumor in our clinic between January 2011 and September 2021 were reviewed retrospectively. The demographic characteristics of the patients, their complaints, neurological examinations, operation areas, pathological diagnoses, complications, and whether other postoperative treatments were performed were evaluated.
Results: Eighty pediatric patients with posterior fossa tumors were 43 females and 37 males. While 65 patients were operated for the first time, 8 patients were reoperated for residual tumors and 4 patients for recurrent tumors. Tumor was removed totally in 60 patients, subtotal (residual <3 cm²) in 20 patients. The most common tumor pathologies were medulloblastoma and pilocytic astrocytoma. Headache is the most common complaint at admission. Ependymomas had the youngest group of patients at the time of admission. Hydrocephalus developed in 7 of the cases postoperatively and a ventriculoperitoneal shunt was inserted. The need for ventriculoperitoneal shunt was observed more in medulloblastoma patients. The most common postoperative complication was deterioration in cerebellar tests.
Conclusion: Surgery with safe resection remains the mainstay of treatment for pediatric posterior fossa tumors. It should be noted that the treatment of pediatric posterior fossa tumors is a team effort. Prospective studies with well-defined algorithms are needed to reduce complications and mortality.

Keywords

Pediatric posterior fossa tumors, hydrocephalus, cerebrospinal fluid leak, tumors

Çocukluk çağı posterior fossa tümörlerinin retrospektif değerlendirilmesi- klinik deneyimimiz

Abstract

Amaç: Bu çalışmada amacımız, üçüncü basamak bir üniversite hastanesinin pediatrik posterior fossa tümörlerinin tanı ve tedavisini retrospektif olarak olarak değerlendirmektir.

Gereç ve yöntem: Kliniğimizde Ocak 2011-Eylül 2021 tarihleri arasında posterior fossa tümörü nedeni ile opere olan pediatrik hastaların dosyaları retrospektif olarak incelendi. Hastaların demografik özellikleri, başvuru şikayetleri, nörolojik muayeneleri, operasyon bölgeleri, patolojik tanıları, postoperative dönemde komplikasyon gelişip gelişmediği, postoperatif başka tedavilerin uygulanıp uygulanmadığı açısından incelendi.

Bulgular: Seksen pediatrik posterior fossa tümörü bulunan hastanın 43 tanesi kadın, 37 tanesi erkek idi. 65 hasta ilk defa opere edilirken, 8 hasta rezidü ve 4 hasta nüks tümör nedeni ile tekrar opere edildi. 60 hastada tümör total olarak çıkarılırken, 20 hastada subtotal (rezidü <3 cm²) çıkarıldı. En sık rastlanan tümör patolojisi medulloblastom ve pilositik astrositom idi. Hastalar en sık baş ağrısı nedeni ile başvurdular. Ependimomlar başvuru anında en genç hasta grubuna sahipti. Olguların 7 tanesinde postoperatif dönemde hidrosefali gelişti ve ventriküloperitoneal şant takılıldı. Medulloblastom hastalarında ventriküloperitoneal şant ihtiyacı daha fazla izlendi. En sık karşılaşılan postoperatif komplikasyon serebellar testlerde bozulma idi.

Sonuç: Pediatrik posterior fossa tümörlerinde güvenli rezeksiyon ile yapılan cerrahi, tedavinin temeli olmaya devam etmektedir. Pediatrik posterior fossa tümörlerinin tedavisinin bir ekip çalışması olduğu unutulmamalıdır. Komplikasyonları ve mortaliteyi azaltmak için iyi tanımlanmış algoritmalara sahip ileriye dönük çalışmalara ihtiyaç vardır.

Keywords

BOS kaçağı, pediatrik posterior fossa tümörleri, hidrosefali, tümör

References

• Ostrom QT, Gittleman H, Truitt G, Boscia A, Kruchko C, Barnholtz-Sloan JS. CBTRUS Statistical Report: Primary Brain and Other Central Nervous System Tumors Diagnosed in the United States in 2011–2015. NeuroOncol 2018;20 (suppl_4) iv1–iv86. https://doi.org/10.1093/ neuonc/noy131.
• Johnson KJ, Cullen J, Barnholtz-Sloan JS, et al. Childhood brain tumor epidemiology: a brain tumor epidemiology consortium review. Cancer Epidemiol Biomarkers Prev 2014;23(12):2716–2736, https://doi.org/10.1158/1055-9965. epi-14-0207.
• Wilne S, Collier J, Kennedy C, Koller K, Grundy R, Walker D. Presentation of childhood CNS tumours: a systematic review and meta-analysis. Lancet Oncol 2007;8(8):685–695. https:// doi.org/10.1016/S1470-2045(07)70207-3.
• Prasad KSV, Ravi D, Pallikonda V, Raman BVS. Clinicopathological study of pediatric posterior Fossa tumors. J Pediatr Neurosci 2017;12(3):245–250. https://doi. org/10.4103/jpn.JPN_113_16.
• Drevelegas A (Ed.). Imaging of Brain Tumors With Histological Correlations, 2nd ed., Springer-Verlag Berlin Heidelberg, New York, NY, 2011 https://doi.org/ 10.1007/978-3-540-87650-2.
• Alli S, Isik S, Rutka JT. Posterior fossa and brainstem tumors in children, in: Ellenbogen RG, ed. Principles of Neurological Surgery, Philadelphia: Elsevier, 2018; 183–203.
• Moussalem C, Ftouni L , Mrad ZA, et al. Pediatric posterior fossa tumors outcomes: Experience in a tertiary care center in the Middle East Clin Neurol Neurosurg 2020;197:106170 doi: 10.1016/j.clineuro.2020.106170.
• Renne B, Radic J, Agrawal D, et al. Cerebellar mutism after posterior fossa tumor resection in children: a multicenter international retrospective study to determine possible modifiable factors. Childs Nerv Syst 2020;36(6):1159-1169. doi: 10.1007/s00381-019-04058-7.
• Pitsika M, Tsitouras V. Cerebellar mutism. J Neurosurg Pediatr 2013:12(6):604–614. https://doi.org/10.3171/2013.8.PEDS13168.
• Catsman-Berrevoets CE, Van Dongen HR, Mulder PGH, Paz y Geuze D, Paquier PF, Lequin MH. Tumour type and size are high risk factors for the syndrome of "cerebellar" mutism and subsequent dysarthria, J Neurol Neurosurg Psychiatry 1999;67(6):755-7. doi: 10.1136/jnnp.67.6.755.
• Steinbok P, Singhal A, Mills J, Cochrane DD, Price AV. Cerebrospinal fluid (CSF) leak and pseudomeningocele formation after posterior fossa tumor resection in children: a retrospective analysis. Childs Nerv Syst 2007;23 (2): 171–174. https://doi.org/ 10.1007/s00381-006-0234-0.
• Manley GT, Dillon W. Acute posterior fossa syndrome following lumbar drainage for treatment of suboccipital pseudomeningocele. Report of three cases, J Neurosurg 2000; 92 (3): 469–474. https://doi.org/10.3171/ jns.2000.92.3.0469.
• Ruggiero C, Cinalli G, Spennato P, et al. Endoscopic third ventriculostomy in the treatment of hydrocephalus in posterior fossa tumors in children. Childs Nerv Syst 2004; 20 (11-12): 828–833. https://doi.org/10.1007/s00381-004-0938-y.