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Child's Nervous System
Published in: Child's Nervous System 5/2013

01-05-2013 | Original Paper

A comprehensive analysis of early outcomes and complication rates after 769 craniotomies in pediatric patients

Authors: M. von Lehe, H.-J. Kim, J. Schramm, M. Simon

Published in: Child's Nervous System | Issue 5/2013

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Abstract

Purpose

Perioperative complications following craniotomy in pediatric neurosurgery have received little attention. We analyzed perioperative complications and early outcomes following craniotomy in a large cohort of pediatric patients.

Methods

A retrospective chart review identified 769 operations (27 % epilepsy surgery, 26 % trauma, 21 % tumor, 7 % vascular, 4 % infections, 14 % other, and 88 % supratentorial) in 641 patients <16 years (mean age 8.5 years). We recorded all perioperative complications and functional outcomes 30 days after surgery.

Results

Excluding epilepsy surgery cases, 17.5 % patients had emergency surgery. There were 38 new major neurological deficits (5.0 %; excluding deficits incurred as part of the surgical strategy). New neurological deficits occurred more frequently following operations for brain tumors, when compared to other surgeries (P < 0.001), and after surgery for infratentorial lesions (P < 0.001). Local complications occurred in 3.9 %, systemic complications in 2.5 % of patients. Ventricular shunting or endoscopic ventriculostomy was necessary in 87 patients (11.3 %). Surgical mortality was 2.0 % (including moribund patients after trauma or vascular incidence). Preoperative Karnofsky Performance Index (KPI) and the incurrence of new neurological deficits proved the most powerful predictors of functional outcome. Emergency surgery or repeat craniotomies were not correlated with increased rates of local complications.

Conclusions

Craniotomies for pediatric patients carry a low morbidity and mortality. Systemic complications seem to occur less often in the pediatric than in the adult population. Good surgical outcomes require a proper balance between local pediatric neurosurgical care for emergency cases and centralized treatment of more difficult cases.
Literature
1.
Albright AL, Pollack IF, Adelson PD, Solot JJ (1999) Outcome data and analysis in pediatric neurosurgery. Neurosurgery 45(1):101–106PubMedCrossRef
2.
Allibone JB, Harkness WJ, Hayward RD (1999) Craniotomy-related complications in a paediatric neurosurgery unit—a prospective study. Br J Neurosurg 13(2):148–153PubMedCrossRef
3.
Barker FG 2nd, Curry WT Jr, Carter BS (2005) Surgery for primary supratentorial brain tumors in the United States, 1988 to 2000: the effect of provider caseload and centralization of care. Neuro Oncol 7(1):49–63PubMedCrossRef
4.
Behrens E, Schramm J, Zentner J, Konig R (1997) Surgical and neurological complications in a series of 708 epilepsy surgery procedures. Neurosurgery 41(1):1–9, discussion 9–10PubMedCrossRef
5.
Brell M, Ibanez J, Caral L, Ferrer E (2000) Factors influencing surgical complications of intra-axial brain tumours. Acta Neurochir (Wien) 142(7):739–750CrossRef
6.
Chang SM, Parney IF, McDermott M, Barker FG 2nd, Schmidt MH, Huang W, Laws ER Jr, Lillehei KO, Bernstein M, Brem H, Sloan AE, Berger M (2003) Perioperative complications and neurological outcomes of first and second craniotomies among patients enrolled in the Glioma Outcome Project. J Neurosurg 98(6):1175–1181PubMedCrossRef
7.
Clusmann H, Kral T, Marin G, Van Roost D, Swamy K, Schramm J (2004) Characterization of hemorrhagic complications after surgery for temporal lobe epilepsy. Zentralbl Neurochir 65(3):128–134PubMedCrossRef
8.
Cowan JA Jr, Dimick JB, Leveque JC, Thompson BG, Upchurch GR Jr, Hoff JT (2003) The impact of provider volume on mortality after intracranial tumor resection. Neurosurgery 52(1):48–53, discussion 53–44PubMed
9.
Curry WT, McDermott MW, Carter BS, Barker FG 2nd (2005) Craniotomy for meningioma in the United States between 1988 and 2000: decreasing rate of mortality and the effect of provider caseload. J Neurosurg 102(6):977–986PubMedCrossRef
10.
Dashti SR, Baharvahdat H, Spetzler RF, Sauvageau E, Chang SW, Stiefel MF, Park MS, Bambakidis NC (2008) Operative intracranial infection following craniotomy. Neurosurg Focus 24(6):E10PubMedCrossRef
11.
Hassaneen W, Levine NB, Suki D, Salaskar AL, de Moura LA, McCutcheon IE, Prabhu SS, Lang FF, DeMonte F, Rao G, Weinberg JS, Wildrick DM, Aldape KD, Sawaya R (2011) Multiple craniotomies in the management of multifocal and multicentric glioblastoma. Clinical article J Neurosurg 114(3):576–584CrossRef
12.
Kalfas IH, Little JR (1988) Postoperative hemorrhage: a survey of 4992 intracranial procedures. Neurosurgery 23(3):343–347PubMedCrossRef
13.
Korinek AM, Golmard JL, Elcheick A, Bismuth R, van Effenterre R, Coriat P, Puybasset L (2005) Risk factors for neurosurgical site infections after craniotomy: a critical reappraisal of antibiotic prophylaxis on 4,578 patients. Br J Neurosurg 19(2):155–162PubMedCrossRef
14.
Lansky SB, List MA, Lansky LL, Ritter-Sterr C, Miller DR (1987) The measurement of performance in childhood cancer patients. Cancer 60(7):1651–1656PubMedCrossRef
15.
Lassen B, Helseth E, Egge A, Due-Tonnessen BJ, Ronning P, Meling TR (2012) Surgical mortality and selected complications in 273 consecutive craniotomies for intracranial tumors in pediatric patients. Neurosurgery 70(4):936–943, discussion 943PubMedCrossRef
16.
Lassen B et al (2011) Surgical mortality at 30 days and complications leading to recraniotomy in 2630 consecutive craniotomies for intracranial tumors. Neurosurgery 68(5):1259–1268, discussion 1268–1259PubMed
17.
Luyken C, Blumcke I, Fimmers R, Urbach H, Elger CE, Wiestler OD, Schramm J (2003) The spectrum of long-term epilepsy-associated tumors: long-term seizure and tumor outcome and neurosurgical aspects. Epilepsia 44(6):822–830PubMedCrossRef
18.
Musleh W, Yassari R, Hecox K, Kohrman M, Chico M, Frim D (2006) Low incidence of subdural grid-related complications in prolonged pediatric EEG monitoring. Pediatr Neurosurg 42(5):284–287PubMedCrossRef
19.
Neervoort FW, Van Ouwerkerk WJ, Folkersma H, Kaspers GJ, Vandertop WP (2010) Surgical morbidity and mortality of pediatric brain tumors: a single center audit. Childs Nerv Syst 26(11):1583–1592PubMedCrossRef
20.
Onal C, Otsubo H, Araki T, Chitoku S, Ochi A, Weiss S, Elliott I, Snead OC 3rd, Rutka JT, Logan W (2003) Complications of invasive subdural grid monitoring in children with epilepsy. J Neurosurg 98(5):1017–1026PubMedCrossRef
21.
Rabadan AT et al (2007) Factors related to surgical complications and their impact on the functional status in 236 open surgeries for malignant tumors in a Latino-American hospital. Surg Neurol 68(4):412–420, discussion 420PubMedCrossRef
22.
Riva-Cambrin J, Detsky AS, Lamberti-Pasculli M, Sargent MA, Armstrong D, Moineddin R, Cochrane DD, Drake JM (2009) Predicting postresection hydrocephalus in pediatric patients with posterior fossa tumors. J Neurosurg Pediatr 3(5):378–385PubMedCrossRef
23.
Sawaya R et al (1998) Neurosurgical outcomes in a modern series of 400 craniotomies for treatment of parenchymal tumors. Neurosurgery 42(5):1044–1055, discussion 1055–1046PubMedCrossRef
24.
Sharma BS, Sinha S, Mehta VS, Suri A, Gupta A, Mahapatra AK (2007) Pediatric intracranial aneurysms—clinical characteristics and outcome of surgical treatment. Childs Nerv Syst 23(3):327–333PubMedCrossRef
25.
Smith ER, Butler WE, Barker FG (2004) Craniotomy for resection of pediatric brain tumors in the United States, 1988 to 2000: effects of provider caseloads and progressive centralization and specialization of care. Neurosurgery 54(3):553–563, discussion 563–555PubMedCrossRef
26.
Valentini LG, Casali C, Chatenoud L, Chiaffarino F, Uberti-Foppa C, Broggi G (2008) Surgical site infections after elective neurosurgery: a survey of 1747 patients. Neurosurgery 62(1):88–95, discussion 95–86PubMedCrossRef
Metadata
Title
A comprehensive analysis of early outcomes and complication rates after 769 craniotomies in pediatric patients
Authors
M. von Lehe
H.-J. Kim
J. Schramm
M. Simon
Publication date
01-05-2013
Publisher
Springer-Verlag
Published in
Child's Nervous System / Issue 5/2013
Print ISSN: 0256-7040
Electronic ISSN: 1433-0350
DOI
https://doi.org/10.1007/s00381-012-2006-3

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