目的:小儿神经肿瘤外科并发症的报道很少且不一致。这项研究量化了过去十年中小儿脑肿瘤手术后的手术发病率,使用现有的发病率和结局指标。
方法:作者确定了2008年1月至2018年12月期间在一个三级儿科神经外科中心接受颅内肿瘤手术的所有儿科患者。术后第0天和第30天之间的并发症被前瞻性记录使用适当的现有发病率量表进行分级。即,Clavien-Dindo(CD),Landriel,和德雷克音阶.还记录了相对于预定手术目标的手术结果。
结果:335例患者(男188例,行开颅手术者共477例(364例,活检者共113例),中位年龄9岁)。总体30天死亡率为1.26%(n=6),没有死亡是手术并发症的直接结果。CD量表上的发病率为0,占55.14%,10.69%中的1个,18.66%中的2个,3A在1.47%,3B在11.74%,和4在1.05%的病例中。在139例(29.14%)中观察到Drake分类的发病率。在30天仍然存在的神经功能缺损占8.39%;手术室的收益中有78%用于CSF转移。
结论:据作者所知,这是介绍小儿脑肿瘤手术结局和发病率的最大系列.Drake分类的死亡率和发病率与已发表的系列相当。需要一种改进的工具来量化小儿神经肿瘤手术的发病率。
Complications in pediatric neurooncology surgery are seldom and inconsistently reported. This study quantifies surgical morbidity after pediatric brain tumor surgery from the last decade in a single center, using existing morbidity and outcome measures.
The authors identified all pediatric patients undergoing surgery for an intracranial tumor in a single tertiary pediatric neurosurgery center between January 2008 and December 2018. Complications between postoperative days 0 and 30 that had been recorded prospectively were graded using appropriate existing morbidity scales, i.e., the Clavien-Dindo (CD), Landriel, and
Drake scales. The result of surgery with respect to the predetermined surgical aim was also recorded.
There were 477 cases (364 craniotomies and 113 biopsies) performed on 335 patients (188 males, median age 9 years). The overall 30-day mortality rate was 1.26% (n = 6), and no deaths were a direct result of surgical complication. Morbidity on the CD scale was 0 in 55.14%, 1 in 10.69%, 2 in 18.66%, 3A in 1.47%, 3B in 11.74%, and 4 in 1.05% of cases. Morbidity using the
Drake classification was observed in 139 cases (29.14%). Neurological deficit that remained at 30 days was noted in 8.39%; 78% of the returns to the operative theater were for CSF diversion.
To the authors\' knowledge, this is the largest series presenting outcomes and morbidity from pediatric brain tumor surgery. The mortality rate and morbidity on the
Drake classification were comparable to those of published series. An improved tool to quantify morbidity from pediatric neurooncology surgery is necessary.