A Retrospective Study of Pediatric Posterior Fossa Tumors: Was the Outcome Different in Patients Undergoing Elective versus Emergency Surgery?

Author(s): Ashutosh Kumar [1]; Suyash Singh [2]; Aanchal Datta [1]; Kamlesh Singh Bhaisora [1]; Jayesh Sardhara [1]; Priyadarshi Dikshit [1]; Ved Prakash Maurya [1]; Pawan Kumar Verma [1]; Kuntal Kanti [...]
Background: Pediatric posterior fossa tumors (pPFTs) may present acutely with features of increased intracranial pressure that need urgent intervention or with stable symptoms requiring elective management. In this article, we have analyzed the outcomes of pPFTs managed under three arms: (1) emergency tumor resection (A), (2) elective tumor resection (B), and (3) pre-resection cerebrospinal spinal fluid (CSF) diversion followed by elective tumor resection (C). Materials and Methods: We retrospectively reviewed our database from July 2012 to March 2020 for pediatric patients (age ≤16 years) with PFTs. The patients were classified into three groups based on the timing and type of intervention. Their result was assessed as the primary (postoperative complications) and secondary outcomes (post-resection CSF diversion, CSF diversion failure, residual tumor, and survival). A P value < 0.05 was considered significant (SPSS version 22.0, IBM, New York). Results: A total of 154 patients (M:F 2.42:1) were included with a mean age of 8.1 (SD ± 4.2)-years (range 1-16). Group B (n 72/46.8%) had a significantly higher number of patients as compared to the group A (n 40/26%) and group C (n 42/27.3%) (χ[sup.2] test, P value 0.02). The primary outcomes were comparable between group A and group B. A higher incidence of preoperative external ventricular drain insertion and post-resection CSF diversion failure was noted in group A as compared to group B (P value < 0.01). Group C had a significantly higher proportion of patients with residual tumor (n 19/48.7%) as compared to group A (n 11/29.7%, P value 0.09) and group B (n 20/ 29.4%,P value < 0.05). The post-resection CSF diversion failure rate was significantly higher in group C than in the other two groups (P value < 0.05). Conclusion: The pre-resection CSF diversion subgroup had a poorer outcome as compared to elective and emergency tumor resection. The outcomes of elective and emergency resection of pPFTs were comparable, except for the higher risk of shunt failure in the emergency cohort. Keywords: Elective, emergency, external ventricular drain, pediatric posterior fossa tumors, pre-resection CSF diversion