Complications Following Resection of Midline Posterior Fossa Tumors in Children

Mini Jayan; Dhaval P Shukla; Marimuthu Palaniyappan; Binukumar Bhaskarapillai; Indira Devi B

doi:10.33883/jms.v24i1.825

Mini Jayan Research Associate
Dhaval P Shukla National Institute of Mental Health and Neurosciences (NIMHANS)
Marimuthu Palaniyappan National Institute of Mental Health and Neurosciences (NIMHANS)
Binukumar Bhaskarapillai National Institute of Mental Health and Neurosciences (NIMHANS)
Indira Devi B National Institute of Mental Health and Neurosciences (NIMHANS) http://orcid.org/0000-0003-3272-2465

DOI: https://doi.org/10.33883/jms.v24i1.825

Keywords: midline posterior fossa, complications, posterior fossa syndrome, pneumocephalus, gaze palsy

Abstract

Introduction: The midline posterior fossa is a common site of origin of brain tumors in children. The midline posterior fossa comprises critical neural structures like the floor of the fourth ventricle and vermis. Injury to any of these structures can result in a myriad of complications. In this study, we investigated the complications of surgery of posterior fossa tumors in children treated at our hospital to determine their predicting factors.

Methods: A retrospective review was carried out to explore the complications of surgery of posterior fossa tumors. A total of 246 children who had undergone surgery for posterior fossa tumors between 1st Jan 2006 and 31st Dec 2016 were considered for this study. A Chi-square test was done to check the association of complications with various factors. Binary logistic regression was performed to predict the occurrence of complications of surgical procedures and also to determine the predictive factors of each of the complications.

Results: Of the 246 children studied, 71(29%) had at least one neurological complication. The complications were classified as general and neurological; general complications included cerebrospinal fluid (CSF) infection, postoperative hematoma requiring evacuation, pseudomeningocele, pneumocephalus, fever; and neurological complications included cranial nerve deficits, long tract signs, and cerebellar dysfunction. Among the cranial nerve palsy, the commonest were 6th and 7th nerve palsy. Cerebellar mutism was noted in 9(3.7%) of the children. Other complications were twelfth nerve palsy, ataxia, limb weakness, headache and vomiting, fever, poor surgical wound healing, CSF leak, pseudomeningocoele, and subdural hygroma. A Chi-square test was done to check the association of complication with various factors of which only post-operative impairment scale was found to be associated (????2=4.97, p-value=0.035). The odds of complication for near-total resection were 1.94 times more than that of total resection, which was statistically significant (p-value = 0.04). For patients who had undergone shunt preoperatively, the odds of a complication were 53% less than those who had not. When each type of complication was analyzed individually, age below three years and extension beyond midline/spinal seeding were significant predictors of pneumocephalus, and subtotal resection was a significant predictor of gaze palsy.

Conclusion: Complications were not infrequent after surgery for midline posterior fossa in children. The extent of resection and pre-operative shunt were the main determinants of complications. Younger age and extension beyond midline/spinal seeding were contributory factors for pneumocephalus and subtotal resection a contributory factor for gaze palsy.

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Author Biographies

Dhaval P Shukla, National Institute of Mental Health and Neurosciences (NIMHANS)

Professor, Department of Neurosurgery.

Marimuthu Palaniyappan, National Institute of Mental Health and Neurosciences (NIMHANS)

Professor and Head, Department of Biostatistics

Binukumar Bhaskarapillai, National Institute of Mental Health and Neurosciences (NIMHANS)

Associate Professor, Department of Biostatistics

Indira Devi B, National Institute of Mental Health and Neurosciences (NIMHANS)

Dean Neurosciences and Professor Department of Neurosurgery

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