Bryan Renne1, Julia Radic2, Deepak Agrawal3, Brittany Albrecht4, Christopher M Bonfield5, Gesa Cohrs6, Taylor Davis4, Ashok Gupta7, Andrea L O Hebb8, Maria Lamberti-Pasculli9, Friederike Knerlich-Lukoschus6, Spencer Lindsay4, P Daniel McNeely8, Shibu Pillai10, Hitesh Inder Singh Rai3, Katherine D Sborov5, Aleksander Vitali2, Simon Walling8, Peter Woerdeman11, Wihasto Suryaningtyas12, Douglas Cochrane9, Ash Singhal13, Paul Steinbok13. 1. Faculty of Medicine, University of British Columbia, Vancouver, Canada. bryan@renne.org. 2. Division of Neurosurgery, Royal University Hospital, University of Saskatchewan, Saskatoon, Canada. 3. Department of Neurosurgery and Gamma Knife, All India Institute of Medical Sciences, New Delhi, India. 4. University of Saskatchewan College of Medicine, Saskatoon, Canada. 5. Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, TN, USA. 6. Department of Neurosurgery, University Hospital of Schleswig-Holstein, Campus Kiel, Kiel, Germany. 7. Department of Neurosurgery, SMS Medical College, Jaipur, Rajasthan, India. 8. Division of Neurosurgery, IWK Health Centre, Halifax, Canada. 9. Division of Neurosurgery, The Hospital for Sick Children, Toronto, Canada. 10. Department of Neurosurgery, Mazumdar Shaw Medical Center, Narayana Health, Bangalore, India. 11. Department of Neurosurgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands. 12. Department of Neurosurgery, Faculty of Medicine, Universitas Airlangga and Dr. Soetomo General Hospital, Surabaya, Indonesia. 13. Division of Neurosurgery, Department of Surgery, British Columbia Children's Hospital and University of British Columbia, Vancouver, Canada.
Abstract
PURPOSE: A preliminary survey of pediatric neurosurgeons working at different centers around the world suggested differences in clinical practice resulting in variation in the risk of pediatric cerebellar mutism (CM) and cerebellar mutism syndrome (CMS) after posterior fossa (PF) tumor resection. The purposes of this study were (1) to determine the incidence and severity of CM and CMS after midline PF tumor resection in children treated at these centers and (2) to identify potentially modifiable factors related to surgical management (rather than tumor biology) that correlate with the incidence of CM/CMS. METHODS: Attending pediatric neurosurgeons at British Columbia's Children's Hospital (BCCH) and neurosurgeons who completed a pediatric neurosurgery fellowship at BCCH were invited to provide data from the center where they currently practiced. Children aged from birth to less than 18 years who underwent initial midline PF tumor resection within a contemporary, center-selected 2-year period were included. Data was obtained by retrospective chart and imaging review. Modifiable surgical factors that were assessed included pre-resection surgical hydrocephalus treatment, surgical positioning, ultrasonic aspirator use, intraoperative external ventricular drain (EVD) use, surgical access route to the tumor, and extent of resection. CM was defined as decreased or absent speech output postoperatively and CMS as CM plus new or worsened irritability. RESULTS: There were 263 patients from 11 centers in 6 countries (Canada, Germany, the Netherlands, India, Indonesia, and the USA). Median age at surgery was 6 years (range < 1 to 17 years). The overall incidence of postoperative CM was 23.5% (range 14.7-47.6% for centers with data on ≥ 20 patients). The overall incidence of CMS was 6.5% (range 0-10.3% for centers contributing data on ≥ 20 patients). A multivariate logistic regression on the full data set showed no significant association between pre-resection surgical hydrocephalus treatment, prone position, ultrasonic aspirator use, EVD use, telovelar approach, complete or near total resection, or treating center and either postoperative CM or CMS. CONCLUSIONS: While there was variation in surgical management of midline PF tumors among centers participating in this study, the factors in management that were examined did not predict postoperative CM or CMS.
PURPOSE: A preliminary survey of pediatric neurosurgeons working at different centers around the world suggested differences in clinical practice resulting in variation in the risk of pediatric cerebellar mutism (CM) and cerebellar mutism syndrome (CMS) after posterior fossa (PF) tumor resection. The purposes of this study were (1) to determine the incidence and severity of CM and CMS after midline PF tumor resection in children treated at these centers and (2) to identify potentially modifiable factors related to surgical management (rather than tumor biology) that correlate with the incidence of CM/CMS. METHODS: Attending pediatric neurosurgeons at British Columbia's Children's Hospital (BCCH) and neurosurgeons who completed a pediatric neurosurgery fellowship at BCCH were invited to provide data from the center where they currently practiced. Children aged from birth to less than 18 years who underwent initial midline PF tumor resection within a contemporary, center-selected 2-year period were included. Data was obtained by retrospective chart and imaging review. Modifiable surgical factors that were assessed included pre-resection surgical hydrocephalus treatment, surgical positioning, ultrasonic aspirator use, intraoperative external ventricular drain (EVD) use, surgical access route to the tumor, and extent of resection. CM was defined as decreased or absent speech output postoperatively and CMS as CM plus new or worsened irritability. RESULTS: There were 263 patients from 11 centers in 6 countries (Canada, Germany, the Netherlands, India, Indonesia, and the USA). Median age at surgery was 6 years (range < 1 to 17 years). The overall incidence of postoperative CM was 23.5% (range 14.7-47.6% for centers with data on ≥ 20 patients). The overall incidence of CMS was 6.5% (range 0-10.3% for centers contributing data on ≥ 20 patients). A multivariate logistic regression on the full data set showed no significant association between pre-resection surgical hydrocephalus treatment, prone position, ultrasonic aspirator use, EVD use, telovelar approach, complete or near total resection, or treating center and either postoperative CM or CMS. CONCLUSIONS: While there was variation in surgical management of midline PF tumors among centers participating in this study, the factors in management that were examined did not predict postoperative CM or CMS.
Authors: J Kjær Grønbæk; S Toescu; R Frič; P Nilsson; C Castor; C Mallucci; B Pizer; K Aquilina; E Molinari; M Aasved Hjort; A Karppinen; G Rutkauskiene; K Mudra; B Markia; K van Baarsen; E Hoving; J Zipfel; M Wibroe; K Nysom; K Schmiegelow; A Sehested; R Mathiasen; M Juhler Journal: Childs Nerv Syst Date: 2022-02-14 Impact factor: 1.475
Authors: Rashad Jabarkheel; Nisreen Amayiri; Derek Yecies; Yuhao Huang; Sebastian Toescu; Liana Nobre; Donald J Mabbott; Sniya V Sudhakar; Prateek Malik; Suzanne Laughlin; Maisa Swaidan; Maysa Al Hussaini; Awni Musharbash; Geeta Chacko; Leni G Mathew; Paul G Fisher; Darren Hargrave; Ute Bartels; Uri Tabori; Stefan M Pfister; Kristian Aquilina; Michael D Taylor; Gerald A Grant; Eric Bouffet; Kshitij Mankad; Kristen W Yeom; Vijay Ramaswamy Journal: Neuro Oncol Date: 2020-02-20 Impact factor: 12.300