gms | German Medical Science

Objective: Perioperative complications following craniotomy for tumour resection in adult patients have been analyzed in considerable detail. Similar data for pediatric patients are lacking. Hence, the authors have reviewed their experience in this latter patient population.

Methods: A retrospective chart review was performed for all patients <16 years undergoing surgery for brain tumours at the author’s institution between March 1989 and July 2006. 235 craniotomies (69.4% supratentorial) were performed in 189 patients (mean 8.5 years). 33 patients (17.5%) had two and 6 (3.2%) three or more craniotomies. We recorded all perioperative complications and neurological outcomes after the first 30 days following surgery.

Results: New deficits occurred after 17/72 (23.6%) posterior fossa, but only after 11/163 (6.7%) supratentorial craniotomies (P<0.001). However, significant worsening of the preoperative performance status (worsening of modified KPI: >20 points) was seen in only 2.6% of the children. There were 6 local infectious complications (2.6%), 4 postoperative bleedings necessitating revision surgery (1.7%), and 9 severe systemic complications (3.8%; pneumonia, sepsis etc.). Surgical mortality was 0.4%. Ventricular shunting or endoscopic ventriculostomy proved necessary in 33/72 (45.8%) of children with posterior fossa tumors, and after 13/163 (8.0%) supratentorial craniotomies (P<0.001).

Conclusions: Local complication rates and neurological outcomes after craniotomy for pediatric patients compare favourably with similar data from adult series. Surgery for posterior fossa tumors carries a relatively increased risk for neurological worsening. Children with infratentorial tumors surprisingly often need a permanent CSF shunt or ventriculostomy. Systemic complications seem to occur less often in the pediatric population. The authors’ data could be used as a reference by those involved in the planning and organisation of pediatric neurosurgical care.