The satisfactory surgical outcome of posterior fossa brain tumors in children at civil hospital, karachi

Introduction: Posterior fossa brain tumor is the most devastating forms of human illness, primarily because of the limited space within the posterior fossa, the potential involvement of vital brain stem nuclei, and the mass effect causes obstructive hydrocephalus. Posterior fossa tumors are more common in children than adults. The Objective of the Study: To find out the satisfactory surgical outcome of posterior fossa brain tumors in children at Civil hospital, Karachi. Materials and Methods and Duration of Study Setting: This prospective observational, case series study was conducted from February 2015 to February 2105 in the Department of neurosurgery, Dow University of Health Sciences, Civil Hospital, Karachi, Karachi. Postoperative patients with the diagnosis of posterior fossa tumor were enrolled in the study. Detailed history, physical examination, anthropometrics, and biochemical measurements were recorded. Magnetic resonance imaging was done to determine the satisfactory surgical outcome. Patients were followed up at the third postoperative month to determine the satisfactory surgical outcome. Results: Seventy-one patients fulfilling the inclusion criteria, the mean ± standard deviation age of the study population was 6.63 ± 3.181 years. 29 (40.8%) were <7 years of age and 42 (59.2%) were of age 7 years and above. 50 (70.4%) were males and 21 (29.6%) were females. 49 (69%) patients presented with vomiting. 34 (47.9%) presented with seizures. (40.8%) had papilledema. (25.4%) presented with hemiparesis. 8 (11.3%) had meningismus. On analysis of the frequency of outcome variables (80.3%) achieved the satisfactory surgical outcome. Conclusions: There has been no major study to determine satisfactory surgical outcome in postoperative patients with posterior fossa brain tumor in our population. The study was to provide local data in our population and compare it to the international data. This may help in proper patient management. Majority of the patients had satisfactory surgical outcome. The absence of papilledema, hemiparesis, and meningismus had more chances of satisfactory surgical outcome.

Key-words:

Magnetic resonance imaging - posterior fossa - seizures - tumor

Financial support and sponsorship

Nil.

Publication History

Received: 04 March 2019

Accepted: 08 August 2019

Article published online:
16 August 2022

• References

• 1 Ramanan M, Chaseling R. Paediatric brain tumours treated at a single, tertiary paediatric neurosurgical referral centre from 1999 to 2010 in Australia. J Clin Neurosci 2012;19:1387-91.
• 2 Bakhtiar Y, Yonezawa H, Bohara M, Hanaya R, Okamoto Y, Sugiyama K, et al. Posterior fossa immature teratoma in an infant with trisomy 21: A case report and review of the literature. Surg Neurol Int 2012;3:100.
• 3 Frontera WR, Silver JK, Rizzo TD. Essentials of Physical Medicine and Rehabilitation E-Book: Musculoskeletal Disorders, Pain, and Rehabilitation. Elsevier Health Sciences; 2014.
• 4 Witt H, Mack SC, Ryzhova M, Bender S, Sill M, Isserlin R, et al. Delineation of two clinically and molecularly distinct subgroups of posterior fossa ependymoma. Cancer Cell 2011;20:143-57.
• 5 Mpairamidis E, Alexiou GA, Stefanaki K, Manolakos I, Sfakianos G, Prodromou N. Posterior fossa tumor in a 12 year-old boy. Brain Pathol 2009;19:341-2.
• 6 MacDonald T. Medulloblastoma. eMedicine; 2009 Available from: http://emedicine.medscape.com/article/987886-print. [Last accessed on 2014 Nov 11].
• 7 Soffietti R, Baumert BG, Bello L, von Deimling A, Duffau H, Frénay M, et al. Guidelines on management of low-grade gliomas: Report of an EFNS-EANO task force. Eur J Neurol 2010;17:1124-33.
• 8 Stupp R, Brada M, van den Bent MJ, Tonn JC, Pentheroudakis G. ESMO Guidelines Working Group. High-grade glioma: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol 2014;25 Suppl 3:iii93-101.
• 9 Wright KD, Gajjar A. Current treatment options for pediatric and adult patients with ependymoma. Curr Treat Options Oncol 2012;13:465-77.
• 10 Steinbok P, Mangat JS, Kerr JM, Sargent M, Suryaningtyas W, Singhal A, et al. Neurological morbidity of surgical resection of pediatric cerebellar astrocytomas. Childs Nerv Syst 2013;29:1269-75.
• 11 American Cancer Society. Cancer Facts and Figures 2010. Atlanta: American Cancer Society; 2010.
• 12 Ries LA, Smith MA, Gurney JG, Linet M, Tamra T, Young JL, et al., editors. Cancer Incidence and Survival Among Children and Adolescents: United States SEER Program 1975-1995. Bethesda: National Cancer Institute, SEER Program; 1999.
• 13 Little J, editor. Introduction. In: Epidemiology of Childhood Cancer. Lyon: International Agency for Research on Cancer, World Health Organization; 1999.
• 14 Mendonça VG, Lorenzato FR, Mendonça JG, Menezes TC, Guimarães MJ. Uterus cervix cancer mortality: socio-demographic characteristics of women living in the city of Recife, Pernambuco, Brazil. RBdGO 2008;30:248-55.
• 15 Gurney JG, Smith MA, Bunin GR. CNS and miscellaneous intracranial and intraspinal neoplasms. In: Ries LA, Smith MA, Gurney JG, Linet M, Tamra T, Young JL, et al., editors. Cancer Incidence and Survival Among Children and Adolescents: United States SEER Program 1975-1995. Bethesda: National Cancer Institute, SEER Program; 1999.
• 16 Costa EF, Andrade DR, Garcia LM, Ribeiro EH, Miyajima F. Genetic Investigation of Neurotransmitter and Related Genes With Cognitive Ability and Personality. The University of Manchester (United Kingdom); 2007.
• 17 Blaney SM, Kun LE, Hunter J, Rorke-Adams LB, Lau C, Strother D, et al. Tumors of the central nervous system. In: Pizzo PA, Poplack DG, editors. Principles and Practice of Pediatric Oncology. 5th ed. Philadelphia: Lippincot Williams and Wilkins; 2006.
• 18 Schmidt LS, Kamper-Jørgensen M, Schmiegelow K, Johansen C, Lähteenmäki P, Träger C, et al. Infectious exposure in the first years of life and risk of central nervous system tumours in children: Analysis of birth order, childcare attendance and seasonality of birth. Br J Cancer 2010;102:1670-5.
• 19 Reulecke BC, Erker CG, Fiedler BJ, Niederstadt TU, Kurlemann G. Brain tumors in children: Initial symptoms and their influence on the time span between symptom onset and diagnosis. J Child Neurol 2008;23:178-83.
• 20 Wilne SH, Ferris RC, Nathwani A, Kennedy CR. The presenting features of brain tumours: A review of 200 cases. Arch Dis Child 2006;91:502-6.
• 21 Hayashi N, Kidokoro H, Miyajima Y, Fukazawa T, Natsume J, Kubota T, et al. How do the clinical features of brain tumours in childhood progress before diagnosis? Brain Dev 2010;32:636-41.
• 22 Rosemberg S, Fujiwara D. Epidemiology of pediatric tumors of the nervous system according to the WHO 2000 classification: A report of 1,195 cases from a single institution. Childs Nerv Syst 2005;21:940-4.
• 23 Gatta G, Capocaccia R, Coleman MP, Ries LA, Berrino F. Childhood cancer survival in europe and the United States. Cancer 2002;95:1767-72.
• 24 Tseng JH, Tseng MY. Survival analysis of children with primary malignant brain tumors in England and Wales: A population-based study. Pediatr Neurosurg 2006;42:67-73.
• 25 Kameda-Smith MM, White MA, St. George EJ, Brown JI. Time to diagnosis of paediatric posterior fossa tumours: An 11-year West of Scotland experience 2000-2011. Br J Neurosurg 2013;27:364-9.
• 26 Shah SH, Soomro IN, Hussainy AS, Hassan SH. Clinico-morphological pattern of intracranial tumors in children. J Pak Med Assoc 1999;49:63-5.
• 27 Muzumdar D, Ventureyra EC. Treatment of posterior fossa tumors in children. Expert Rev Neurother 2010;10:525-46.
• 28 KlimoPJr., Browd SR, Pravdenkova S, Couldwell WT, Walker ML, Al-Mefty O. The posterior petrosal approach: Technique and applications in pediatric neurosurgery. J Neurosurg Pediatr 2009;4:353-62.
• 29 Teo C, Broggi M. Surgical outcome of patients considered to have “inoperable” tumors by specialized pediatric neuro-oncological multidisciplinary teams. Childs Nerv Syst 2010;26:1219-25.
• 30 Neervoort FW, Van Ouwerkerk WJ, Folkersma H, Kaspers GJ, Vandertop WP. Surgical morbidity and mortality of pediatric brain tumors: A single center audit. Childs Nerv Syst 2010;26:1583-92.
• 31 Cochrane DD, Gustavsson B, Poskitt KP, Steinbok P, Kestle JR. The surgical and natural morbidity of aggressive resection for posterior fossa tumors in childhood. Pediatr Neurosurg 1994;20:19-29.
• 32 Di Rocco C, Chieffo D, Pettorini BL, Massimi L, Caldarelli M, Tamburrini G. Preoperative and postoperative neurological, neuropsychological and behavioral impairment in children with posterior cranial fossa astrocytomas and medulloblastomas: The role of the tumor and the impact of the surgical treatment. Childs Nerv Syst 2010;26:1173-88.
• 33 Rieken S, Gaiser T, Mohr A, Welzel T, Witt O, Kulozik AE, et al. Outcome and prognostic factors of desmoplastic medulloblastoma treated within a multidisciplinary treatment concept. BMC Cancer 2010;10:450.
• 34 De Smet HJ, Baillieux H, Wackenier P, De Praeter M, Engelborghs S, Paquier PF, et al. Long-term cognitive deficits following posterior fossa tumor resection: A neuropsychological and functional neuroimaging follow-up study. Neuropsychology 2009;23:694-704.