Artikel
The influence of pre-diagnostic symptomatic interval (PSI) for neoplastic disorders of the central nervous system in children – a retrospective longitudinal study
Einfluss des prädiagnostischen Intervalls bei Kindern mit Tumoren des zentralen Nervensystems
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Autoren
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Yahya Ahmadipour
- Universitätsklinikum Essen, Klinik für Neurochirurgie und Wirbelsäulenchirurgie, Essen, Deutschland
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Laurèl Rauschenbach
- Universitätsklinikum Essen, Klinik für Neurochirurgie und Wirbelsäulenchirurgie, Essen, Deutschland
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Oliver Gembruch
- Universitätsklinikum Essen, Klinik für Neurochirurgie und Wirbelsäulenchirurgie, Essen, Deutschland
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Daniela Pierscianek
- Universitätsklinikum Essen, Klinik für Neurochirurgie und Wirbelsäulenchirurgie, Essen, Deutschland
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Philipp Dammann
- Universitätsklinikum Essen, Klinik für Neurochirurgie und Wirbelsäulenchirurgie, Essen, Deutschland
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Karsten Henning Wrede
- Universitätsklinikum Essen, Klinik für Neurochirurgie und Wirbelsäulenchirurgie, Essen, Deutschland
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Nicolai El Hindy
- Sankt Christophorus-Krankenhaus Werne, Abteilung für Wirbelsäulen- und Periphere Nervenchirurgie, Essen, Deutschland
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Ulrich Sure
- Universitätsklinikum Essen, Klinik für Neurochirurgie und Wirbelsäulenchirurgie, Essen, Deutschland
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Ramazan Jabbarli
- Universitätsklinikum Essen, Klinik für Neurochirurgie und Wirbelsäulenchirurgie, Essen, Deutschland
| Veröffentlicht: | 26. Juni 2020 |
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Gliederung
Text
Objective: Due to prevalence of non-specific clinical symptoms, timely diagnosis of neoplastic lesions of central nervous system (CNS) lesions might be challenging in pediatric population. Yet whether early diagnosis contributes to better life prognosis and functional outcome is not clear. We examined the time to diagnosis, the so called prediagnostic symptomatic interval (PSI) and its impact on prognosis and functional outcome in children with CNS tumors.
Methods: We retrospectively reviewed the records of 136 patients aged <18 years who were operated with a CNS tumor in our neurosurgical department between January 2010 and December 2015. Tumors entities were analyzed separately and in dichotomous manner according to the WHO classification (III-IV vs I-II). Presence and duration of clinical symptoms before and after surgery were analyzed. Univariate and multivariate analyses were performed.
Results: The median age at diagnosis was 8.3 years (range 3 weeks–17.9 years). The male-to-female ratio was 1:1.2. Pilocytic Astrocytoma occurred as the most common diagnosis in 44 (32.4%) children followed by Anaplastic Ependymoma with 15 (11%). Median evaluated PSI was 74.5 days. Age group of 14 to 16 years revealed a significant higher (p=0.01) PSI. High-grade tumors were characterized with significantly shorter PSI (1.8 vs 3.6 months, p<0.01). Clinical symptoms like impaired vision (p=0.02) and vomiting (p=0.042) were associated with higher PSI whereas coordination disturbances (p=0.02) and increased head circumference (p=0.04) were related to shorter PSI. Overall survival (p=0.75) was not associated with the PSI.
Conclusion: PSI of children with CNS tumors might substantially vary, depending predominantly on the biological grading of the tumor. Moreover, presence of unspecific symptoms in adolescent might also lead to a higher PSI. Probably due to stronger impact of other confounders, timing of diagnosis was not associated with the patients’ survival.
Figure 1 [Fig. 1]
