J Kjær Grønbæk1,2, S Toescu3,4, R Frič5, P Nilsson6, C Castor7, C Mallucci8, B Pizer9, K Aquilina3, E Molinari10, M Aasved Hjort11, A Karppinen12, G Rutkauskiene13, K Mudra14, B Markia15, K van Baarsen16, E Hoving16, J Zipfel17, M Wibroe18, K Nysom18, K Schmiegelow18,19, A Sehested18, R Mathiasen18, M Juhler20,19,21. 1. Department of Neurosurgery, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen E, Denmark. jonathan.kjaer.groenbaek@regionh.dk. 2. Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen E, Denmark. jonathan.kjaer.groenbaek@regionh.dk. 3. Department of Neurosurgery, Great Ormond Street Hospital for Children, Great Ormond Street, London, WC1N 3JH, UK. 4. Developmental Imaging and Biophysics Section, UCL-GOS Institute of Child Health, 30 Guilford St, London, WC1N 1EH, UK. 5. Department of Neurosurgery, Oslo University Hospital, Postboks 4950 Nydalen, 0424, Oslo, Norway. 6. Department of Neuroscience, Section of Neurosurgery, Uppsala University Hospital, 751 85, Uppsala, Sweden. 7. Department of Health Sciences, Lund University, Box 117, 221 00, Lund, Sweden. 8. Department of Paediatric Neurosurgery, Alder Hey Children's NHS Foundation Trust, E. Prescot Road, Liverpool, L14 5AB, UK. 9. School of Health and Life Sciences, University of Liverpool, Brownlow Hill, Liverpool, L69 3BX, UK. 10. Department of Neurology, The Queen Elizabeth University Hospital, University of Glasgow, University Avenue, Glasgow, G12 8QQ, UK. 11. Department of Pediatric Hematology and Oncology, St Olavs Hospital, Postboks 3250 Torgarden, 7006, Trondheim, Norway. 12. Department of Neurosurgery, Helsinki University Hospital and University of Helsinki, P.O. Box 266, N00029, Helsinki, Finland. 13. Department of Pediatrics, Lithuanian University of Health Science, Mickeviciaus 9, 44307, Kaunas, Lithuania. 14. 2Nd Department of Pediatrics, Semmelweis University, Tűzoltó street 7-9, Budapest, Hungary. 15. Neurology and Neurosurgery, National Institute of Mental Health, Laky Adolf u. 44, 1145, Budapest, Hungary. 16. Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, The Netherlands. 17. Department of Neurosurgery, Pediatric Neurosurgery, University Hospital Tuebingen, Hoppe-Seyler-Str. 3, 72076, Tuebingen, Germany. 18. Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen E, Denmark. 19. Institute of Clinical Medicine, Faculty of Medicine, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen, Denmark. 20. Department of Neurosurgery, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen E, Denmark. 21. Department of Neurosurgery, Aarhus University Hospital, Palle Juul-Jensens, Boulevard 99, 8200, Aarhus, Denmark.
Abstract
PURPOSE: Brain tumours constitute 25% of childhood neoplasms, and half of them are in the posterior fossa. Surgery is a fundamental component of therapy, because gross total resection is associated with a higher progression-free survival. Patients with residual tumour, progression of residual tumour or disease recurrence commonly require secondary surgery. We prospectively investigated the risk of postoperative speech impairment (POSI) and cranial nerve dysfunction (CND) following primary and secondary resection for posterior cranial fossa tumours. METHODS: In the Nordic-European study of the cerebellar mutism syndrome, we prospectively included children undergoing posterior fossa tumour resection or open biopsy in one of the 26 participating European centres. Neurological status was assessed preoperatively, and surgical details were noted post-operatively. Patients were followed up 2 weeks, 2 months and 1 year postoperatively. Here, we analyse the risk of postoperative speech impairment (POSI), defined as either mutism or reduced speech, and cranial nerve dysfunction (CND) following secondary, as compared to primary, surgery. RESULTS: We analysed 426 children undergoing primary and 78 undergoing secondary surgery between 2014 and 2020. The incidence of POSI was significantly lower after secondary (12%) compared with primary (28%, p = 0.0084) surgery. In a multivariate analysis adjusting for tumour histology, the odds ratio for developing POSI after secondary surgery was 0.23, compared with primary surgery (95% confidence interval: 0.08-0.65, p = 0.006). The frequency of postoperative CND did not differ significantly after primary vs. secondary surgery (p = 0.21). CONCLUSION: Children have a lower risk of POSI after secondary than after primary surgery for posterior fossa tumours but remain at significant risk of both POSI and CND. The present findings should be taken in account when weighing risks and benefits of secondary surgery for posterior fossa tumours.
PURPOSE: Brain tumours constitute 25% of childhood neoplasms, and half of them are in the posterior fossa. Surgery is a fundamental component of therapy, because gross total resection is associated with a higher progression-free survival. Patients with residual tumour, progression of residual tumour or disease recurrence commonly require secondary surgery. We prospectively investigated the risk of postoperative speech impairment (POSI) and cranial nerve dysfunction (CND) following primary and secondary resection for posterior cranial fossa tumours. METHODS: In the Nordic-European study of the cerebellar mutism syndrome, we prospectively included children undergoing posterior fossa tumour resection or open biopsy in one of the 26 participating European centres. Neurological status was assessed preoperatively, and surgical details were noted post-operatively. Patients were followed up 2 weeks, 2 months and 1 year postoperatively. Here, we analyse the risk of postoperative speech impairment (POSI), defined as either mutism or reduced speech, and cranial nerve dysfunction (CND) following secondary, as compared to primary, surgery. RESULTS: We analysed 426 children undergoing primary and 78 undergoing secondary surgery between 2014 and 2020. The incidence of POSI was significantly lower after secondary (12%) compared with primary (28%, p = 0.0084) surgery. In a multivariate analysis adjusting for tumour histology, the odds ratio for developing POSI after secondary surgery was 0.23, compared with primary surgery (95% confidence interval: 0.08-0.65, p = 0.006). The frequency of postoperative CND did not differ significantly after primary vs. secondary surgery (p = 0.21). CONCLUSION: Children have a lower risk of POSI after secondary than after primary surgery for posterior fossa tumours but remain at significant risk of both POSI and CND. The present findings should be taken in account when weighing risks and benefits of secondary surgery for posterior fossa tumours.
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