All pediatric patients who had undergone intra-axial tumor resection in the posterior fossa between January 2010 and March 2021 were included in the retrospective analysis. Various data points, including demographic, tumor-associated, clinical, radiological, surgery-associated, complications, and follow-up data, were collected and statistically evaluated for an association with CMS.
A total of 63 surgeries in 60 patients were included. The median patient age was 8 years. Pilocytic astrocytoma was the most common tumor type (50%), followed by medulloblastoma (28%) and ependymomas (10%). Complete, subtotal, and partial resection was achieved in 67%, 23%, and 10%, respectively. A telovelar approach had been used the most often (43%) compared with a transvermian approach (8%). Of the 60 children, 10 (17%) had developed CMS and showed marked improvement but with residual deficits. The significant risk factors were a transvermian approach (P = 0.03), vermian splitting when added to another approach (P = 0.002), an initial presentation with acute hydrocephalus (P = 0.02), and hydrocephalus present after tumor surgery (P = 0.004).
Our CMS rate is comparable to those described in the literature. Despite the limitations of the retrospective study design, we found that CMS was not only associated with a transvermian approach but was also associated with a telovelar approach, although to a lesser extent. Acute hydrocephalus at the initial presentation necessitating urgent management was significantly associated with a greater incidence of CMS.
方法:纳入2010年1月至2021年3月接受后颅窝轴向内肿瘤切除术的所有儿科患者进行回顾性分析。各种数据点,包括人口统计,肿瘤相关,临床,放射学,手术相关,收集并发症和随访数据,并对与CMS的相关性进行统计学评估.
结果:纳入60例患者的63例手术,中位年龄为8岁。毛细胞性星形细胞瘤主要占50%,其次是28%的髓母细胞瘤,室管膜瘤占10%.67%的完全切除率与23%的次全切除率相比,部分切除10%。Telovelar方法使用最多的是43%,而transvermian则为8%。10名儿童(17%)发生了CMS,并表现出明显改善,但仍有缺陷。显著的危险因素是超虫方法(p=0.03),每当添加到其他方法时,Vermian分裂(p=0.002),最初表现为急性脑积水(p=0.02),肿瘤手术后仍有脑积水(p=0.004)。
结论:我们的CMS率与文献中描述的比较。尽管我们作为回顾性研究的局限性,我们发现CMS不仅与超虫方法有关,但也发生在使用telovelar方法后,然而,在较小的程度上。初次出现时需要紧急处理的急性脑积水与CMS的发病率较高密切相关。