Mohamed A El Beltagy1,2, Mostafa M E Atteya3,4. 1. Neurosurgery Department, Children's Cancer Hospital Egypt (CCHE, 57357), Cairo, Egypt. beltagy_mohamed@hotmail.com. 2. Neurosurgery Department, Kasr Al-Ainy School of Medicine, Cairo University, Cairo, Egypt. beltagy_mohamed@hotmail.com. 3. Neurosurgery Department, Children's Cancer Hospital Egypt (CCHE, 57357), Cairo, Egypt. 4. Neurosurgery Department, Kasr Al-Ainy School of Medicine, Cairo University, Cairo, Egypt.
Abstract
BACKGROUND: Safe and radical excision of pediatric fourth ventricular tumors is by far the best line of management. Pediatric fourth ventricular tumor surgery is a challenge for neurosurgeons. The aim of the study is to present the authors' experience and to evaluate the possible benefits of neuro-navigated intraoperative ultrasonography (NIOUS) during the surgery of fourth ventricular tumors in children. METHODS: Nonrandomized clinical trial study was conducted on 60 children with fourth ventricular tumors who were treated at Children's Cancer Hospital-Egypt. Mean age was 5.2 (±2.6) years. Thirty cases were operated upon utilizing the conventional microneurosurgical techniques. Another 30 cases were operated upon utilizing the NIOUS technique. RESULTS: Total tumor excision was achieved in 29 cases (96.7%) of NIOUS group versus 24 cases (80%) in the conventional group. Mean operative time NIOUS group was 150 min [standard deviation (SD) = 18.28) versus 140.6 min (SD = 18.6) in the conventional group (p value = 0.055). The mean operative blood loss was 67.5 ml (SD = 17) in NIOUS group versus 71 ml (SD = 15.4) in the conventional group. Postoperative cerebellar mutism occurred in one case (3.3%) of NIOUS group versus in six cases (20%) of the conventional group. CONCLUSIONS: Integration of navigated intraoperative ultrasonography in surgery of pediatric fourth ventricular tumors is a useful technology. It safely monitors maximum stepwise tumor excision. It is associated with less operative morbidity without significantly added operative time. It is a real-time, cost-effective, easily applicable, and easily interpretable tool that could substitute the use of intraoperative MRI especially in pediatric neurosurgery.
BACKGROUND: Safe and radical excision of pediatric fourth ventricular tumors is by far the best line of management. Pediatric fourth ventricular tumor surgery is a challenge for neurosurgeons. The aim of the study is to present the authors' experience and to evaluate the possible benefits of neuro-navigated intraoperative ultrasonography (NIOUS) during the surgery of fourth ventricular tumors in children. METHODS: Nonrandomized clinical trial study was conducted on 60 children with fourth ventricular tumors who were treated at Children's Cancer Hospital-Egypt. Mean age was 5.2 (±2.6) years. Thirty cases were operated upon utilizing the conventional microneurosurgical techniques. Another 30 cases were operated upon utilizing the NIOUS technique. RESULTS: Total tumor excision was achieved in 29 cases (96.7%) of NIOUS group versus 24 cases (80%) in the conventional group. Mean operative time NIOUS group was 150 min [standard deviation (SD) = 18.28) versus 140.6 min (SD = 18.6) in the conventional group (p value = 0.055). The mean operative blood loss was 67.5 ml (SD = 17) in NIOUS group versus 71 ml (SD = 15.4) in the conventional group. Postoperative cerebellar mutism occurred in one case (3.3%) of NIOUS group versus in six cases (20%) of the conventional group. CONCLUSIONS: Integration of navigated intraoperative ultrasonography in surgery of pediatric fourth ventricular tumors is a useful technology. It safely monitors maximum stepwise tumor excision. It is associated with less operative morbidity without significantly added operative time. It is a real-time, cost-effective, easily applicable, and easily interpretable tool that could substitute the use of intraoperative MRI especially in pediatric neurosurgery.
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