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06-03-2023 | Brain Tumor | Original Article

Assessment of the Milan Complexity Scale for prediction of postoperative morbidity in pediatric neuro-oncological surgery

Authors: Kasper Amund Henriksen, Gorm Von Oettingen, Jane Skjøth-Rasmussen, René Mathiasen, Jon Foss-Skiftesvik

Published in: Child's Nervous System | Issue 8/2023

Abstract

Purpose

To assess the performance of the risk-predicting Milan Complexity Scale (MCS) on postoperative morbidity in pediatric neuro-oncological surgery.

Methods

A retrospective dual-center review of children undergoing primary brain tumor resection in Denmark over a 10-year period. MCS scoring was performed based on preoperative imaging, blinded to individual outcomes. Surgical morbidity was registered according to existing complication scales and dichotomized as significant or nonsignificant morbidity. The MCS was evaluated using logistic regression modeling.

Results

208 children (50% female, mean age 7.9 y, and SD 5.2) were included. Of the original “Big Five” predictors included in the MCS, only posterior fossa (OR: 2.31, 95% CI: 1.25–4.34, p-value = 0.008) and eloquent area (OR: 3.32, 95% CI: 1.50–7.68, p-value = 0.004) locations were significantly associated with increased risk of significant morbidity in our pediatric cohort. The absolute MCS score correctly classified 63.0% of cases. Its accuracy increased to 69.2% when mutually adjusting for each of the “Big Five” predictors with corresponding positive and negative predictive values of 66.2% and 71.0%, using a predicted probability cutoff of 0.5.

Conclusion

The MCS is predictive of postoperative morbidity also in pediatric neuro-oncological surgery, although only two of its original five variables were significantly associated with poor outcome in children. The clinical value of the MCS is likely limited for the experienced pediatric neurosurgeon. Future clinically impactful risk-prediction tools should include a larger number of relevant variables and be tailored to the pediatric population.

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Foster MT, Hennigan D, Grayston R et al (2021) Reporting morbidity associated with pediatric brain tumor surgery: are the available scoring systems sufficient? J Neurosurg Pediatr 27:556–565. https://doi.org/10.3171/2020.9.PEDS20556CrossRefPubMed

Lee JK, Brady KM (2018) Developmental cerebrovascular physiology. In: Soriano SG, McClain CDE (eds) Essentials of Pediatric Neuroanesthesia. Cambridge University Press, pp 9–14CrossRef

Drake JM, Riva-Cambrin J, Jea A et al (2010) Prospective surveillance of complications in a pediatric neurosurgery unit. J Neurosurg Pediatr 5:544–548. https://doi.org/10.3171/2010.1.PEDS09305CrossRefPubMed

Wang J, Soriano SG (2018) Developmental approach to the pediatric neurosurgical patient. In: Soriano SG, McClain CDE (eds) Essentials of Pediatric Neuroanesthesia. Cambridge University Press, pp 1–8

von Lehe M, Kim H-J, Schramm J, Simon M (2013) A comprehensive analysis of early outcomes and complication rates after 769 craniotomies in pediatric patients. Childs Nerv Syst ChNS Off J Int Soc Pediatr Neurosurg 29:781–790. https://doi.org/10.1007/s00381-012-2006-3CrossRef

Neervoort FW, Van Ouwerkerk WJR, Folkersma H et al (2010) Surgical morbidity and mortality of pediatric brain tumors: a single center audit. Childs Nerv Syst 26:1583–1592. https://doi.org/10.1007/s00381-010-1086-1CrossRefPubMedPubMedCentral

van Lindert EJ, Arts S, Blok LM et al (2016) Intraoperative complications in pediatric neurosurgery: review of 1807 cases. J Neurosurg Pediatr 18:363–371. https://doi.org/10.3171/2016.3.PEDS15679CrossRefPubMed

Mukerji N, Jenkins A, Nicholson C, Mitchell P (2012) Unplanned reoperation rates in pediatric neurosurgery: a single center experience and proposed use as a quality indicator. J Neurosurg Pediatr 9:665–669. https://doi.org/10.3171/2012.2.PEDS11305CrossRefPubMed

Campbell E, Beez T, Todd L (2017) Prospective review of 30-day morbidity and mortality in a paediatric neurosurgical unit. Childs Nerv Syst ChNS Off J Int Soc Pediatr Neurosurg 33:483–489. https://doi.org/10.1007/s00381-017-3358-5CrossRef

10.

Moiyadi AV, Shetty P (2012) Feasibility of repeat surgery for pediatric brain tumors: an objective assessment of perioperative outcomes. J Neurosurg Pediatr 10:411–417. https://doi.org/10.3171/2012.8.PEDS12133CrossRefPubMed

11.

Sunderland G, Foster MT, Pizer B et al (2021) Evolution of surgical attitudes to paediatric thalamic tumours: the alder hey experience. Childs Nerv Syst ChNS Off J Int Soc Pediatr Neurosurg 37:2821–2830. https://doi.org/10.1007/s00381-021-05223-7CrossRef

12.

Ferroli P, Broggi M, Schiavolin S et al (2015) Predicting functional impairment in brain tumor surgery: the Big Five and the Milan Complexity Scale. Neurosurg Focus 39:E14. https://doi.org/10.3171/2015.9.FOCUS15339CrossRefPubMed

13.

Schrøder H, Rechnitzer C, Wehner PS et al (2016) Danish childhood cancer registry. Clin Epidemiol 8:461–464. https://doi.org/10.2147/CLEP.S99508CrossRefPubMedPubMedCentral

14.

Drake JM, Singhal A, Kulkarni AV et al (2012) Consensus definitions of complications for accurate recording and comparisons of surgical outcomes in pediatric neurosurgery. J Neurosurg Pediatr 10:89–95. https://doi.org/10.3171/2012.3.PEDS11233CrossRefPubMed

15.

Ostrom QT, Price M, Ryan K et al (2022) CBTRUS statistical report: pediatric brain tumor foundation childhood and adolescent primary brain and other central nervous system tumors diagnosed in the United States in 2014–2018. Neuro-Oncol 24:iii1–iii38. https://doi.org/10.1093/neuonc/noac161CrossRefPubMed

16.

Helligsoe ASL, Kenborg L, Henriksen LT et al (2022) Incidence and survival of childhood central nervous system tumors in Denmark, 1997–2019. Cancer Med 11:245–256. https://doi.org/10.1002/cam4.4429CrossRefPubMed

17.

Merchant TE, Pollack IF, Loeffler JS (2010) Brain tumors across the age spectrum: biology, therapy, and late effects. Semin Radiat Oncol 20:58–66. https://doi.org/10.1016/j.semradonc.2009.09.005CrossRefPubMedPubMedCentral

18.

Capper D, Jones DTW, Sill M et al (2018) DNA methylation-based classification of central nervous system tumours. Nature. https://doi.org/10.1038/nature26000CrossRefPubMedPubMedCentral

19.

Jenkins FS, Vasella F, Padevit L et al (2021) Preoperative risk factors associated with new focal neurological deficit and other major adverse events in first-time intracranial meningioma neurosurgery. Acta Neurochir (Wien) 163:2871–2879. https://doi.org/10.1007/s00701-021-04897-xCrossRefPubMed

20.

Azizkhanian I, Matluck N, Ogulnick JV et al (2021) Demographics and outcomes of interhospital transfer patients undergoing intracranial tumor resection: a retrospective cohort analysis. Cureus 13:e17868. https://doi.org/10.7759/cureus.17868CrossRefPubMedPubMedCentral

21.

Tariciotti L, Fiore G, Carapella S et al (2022) A frailty-adjusted stratification score to predict surgical risk, post-operative, long-term functional outcome, and quality of life after surgery in intracranial meningiomas. Cancers 14:3065. https://doi.org/10.3390/cancers14133065CrossRefPubMedPubMedCentral

22.

Milstein JM, Cohen ME, Sinks LF (1985) The influence and reliability of neurologic assessment and Karnofsky performance score on prognosis. Cancer 56:1834–1836. https://doi.org/10.1002/1097-0142(19851001)56:7+%3c1834::aid-cncr2820561323%3e3.0.co;2-aCrossRefPubMed

23.

Lansky SB, List MA, Lansky LL et al (1987) The measurement of performance in childhood cancer patients. Cancer 60:1651–1656. https://doi.org/10.1002/1097-0142(19871001)60:7%3c1651::aid-cncr2820600738%3e3.0.co;2-jCrossRefPubMed

24.

Campbell PG, Malone J, Yadla S et al (2011) Comparison of ICD-9–based, retrospective, and prospective assessments of perioperative complications: assessment of accuracy in reporting: clinical article. J Neurosurg Spine 14:16–22. https://doi.org/10.3171/2010.9.SPINE10151CrossRefPubMed

25.

Trichinopoly Krishna S, Millward C, Mallucci C et al (2022) SURG-13. The COMBAT Project - Core post operative morbidity set for paediatric brain tumours. Neuro-Oncol 24:i144–i145. https://doi.org/10.1093/neuonc/noac079.531CrossRef

Title: Assessment of the Milan Complexity Scale for prediction of postoperative morbidity in pediatric neuro-oncological surgery
Authors: Kasper Amund Henriksen
Gorm Von Oettingen
Jane Skjøth-Rasmussen
René Mathiasen
Jon Foss-Skiftesvik
Publication date: 06-03-2023
Publisher: Springer Berlin Heidelberg
Keywords: Brain Tumor
Pediatric Neurosurgery
Published in: Child's Nervous System / Issue 8/2023
Print ISSN: 0256-7040
Electronic ISSN: 1433-0350
DOI: https://doi.org/10.1007/s00381-023-05902-7

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Assessment of the Milan Complexity Scale for prediction of postoperative morbidity in pediatric neuro-oncological surgery

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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