Postoperative speech impairment and cranial nerve deficits after secondary surgery of posterior fossa tumours in childhood : a prospective European multicentre study
(2022) In Child's Nervous System 38(4). p.747-758- Abstract
Purpose: Brain tumours constitute 25% of childhood neoplasms, and half of them are in the posterior fossa. Surgery is a fundamental component of therapy, because gross total resection is associated with a higher progression-free survival. Patients with residual tumour, progression of residual tumour or disease recurrence commonly require secondary surgery. We prospectively investigated the risk of postoperative speech impairment (POSI) and cranial nerve dysfunction (CND) following primary and secondary resection for posterior cranial fossa tumours. Methods: In the Nordic-European study of the cerebellar mutism syndrome, we prospectively included children undergoing posterior fossa tumour resection or open biopsy in one of the 26... (More)
Purpose: Brain tumours constitute 25% of childhood neoplasms, and half of them are in the posterior fossa. Surgery is a fundamental component of therapy, because gross total resection is associated with a higher progression-free survival. Patients with residual tumour, progression of residual tumour or disease recurrence commonly require secondary surgery. We prospectively investigated the risk of postoperative speech impairment (POSI) and cranial nerve dysfunction (CND) following primary and secondary resection for posterior cranial fossa tumours. Methods: In the Nordic-European study of the cerebellar mutism syndrome, we prospectively included children undergoing posterior fossa tumour resection or open biopsy in one of the 26 participating European centres. Neurological status was assessed preoperatively, and surgical details were noted post-operatively. Patients were followed up 2 weeks, 2 months and 1 year postoperatively. Here, we analyse the risk of postoperative speech impairment (POSI), defined as either mutism or reduced speech, and cranial nerve dysfunction (CND) following secondary, as compared to primary, surgery. Results: We analysed 426 children undergoing primary and 78 undergoing secondary surgery between 2014 and 2020. The incidence of POSI was significantly lower after secondary (12%) compared with primary (28%, p = 0.0084) surgery. In a multivariate analysis adjusting for tumour histology, the odds ratio for developing POSI after secondary surgery was 0.23, compared with primary surgery (95% confidence interval: 0.08–0.65, p = 0.006). The frequency of postoperative CND did not differ significantly after primary vs. secondary surgery (p = 0.21). Conclusion: Children have a lower risk of POSI after secondary than after primary surgery for posterior fossa tumours but remain at significant risk of both POSI and CND. The present findings should be taken in account when weighing risks and benefits of secondary surgery for posterior fossa tumours.
(Less)
- author
- author collaboration
- organization
- publishing date
- 2022-04
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- Cerebellar mutism syndrome, Posterior fossa syndrome, Posterior fossa tumour, Secondary resection
- in
- Child's Nervous System
- volume
- 38
- issue
- 4
- pages
- 12 pages
- publisher
- Springer
- external identifiers
-
- scopus:85127999822
- pmid:35157109
- ISSN
- 0256-7040
- DOI
- 10.1007/s00381-022-05464-0
- language
- English
- LU publication?
- yes
- id
- 593aebf2-82f4-4a61-92d1-41bee5764a3e
- date added to LUP
- 2022-12-28 09:39:11
- date last changed
- 2024-06-28 01:47:49
@article{593aebf2-82f4-4a61-92d1-41bee5764a3e,
abstract = {{<p>Purpose: Brain tumours constitute 25% of childhood neoplasms, and half of them are in the posterior fossa. Surgery is a fundamental component of therapy, because gross total resection is associated with a higher progression-free survival. Patients with residual tumour, progression of residual tumour or disease recurrence commonly require secondary surgery. We prospectively investigated the risk of postoperative speech impairment (POSI) and cranial nerve dysfunction (CND) following primary and secondary resection for posterior cranial fossa tumours. Methods: In the Nordic-European study of the cerebellar mutism syndrome, we prospectively included children undergoing posterior fossa tumour resection or open biopsy in one of the 26 participating European centres. Neurological status was assessed preoperatively, and surgical details were noted post-operatively. Patients were followed up 2 weeks, 2 months and 1 year postoperatively. Here, we analyse the risk of postoperative speech impairment (POSI), defined as either mutism or reduced speech, and cranial nerve dysfunction (CND) following secondary, as compared to primary, surgery. Results: We analysed 426 children undergoing primary and 78 undergoing secondary surgery between 2014 and 2020. The incidence of POSI was significantly lower after secondary (12%) compared with primary (28%, p = 0.0084) surgery. In a multivariate analysis adjusting for tumour histology, the odds ratio for developing POSI after secondary surgery was 0.23, compared with primary surgery (95% confidence interval: 0.08–0.65, p = 0.006). The frequency of postoperative CND did not differ significantly after primary vs. secondary surgery (p = 0.21). Conclusion: Children have a lower risk of POSI after secondary than after primary surgery for posterior fossa tumours but remain at significant risk of both POSI and CND. The present findings should be taken in account when weighing risks and benefits of secondary surgery for posterior fossa tumours.</p>}},
author = {{Grønbæk, J. Kjær and Toescu, S. and Frič, R. and Nilsson, P. and Castor, C. and Mallucci, C. and Pizer, B. and Aquilina, K. and Molinari, E. and Hjort, M. Aasved and Karppinen, A. and Rutkauskiene, G. and Mudra, K. and Markia, B. and van Baarsen, K. and Hoving, E. and Zipfel, J. and Wibroe, M. and Nysom, K. and Schmiegelow, K. and Sehested, A. and Mathiasen, R. and Juhler, M.}},
issn = {{0256-7040}},
keywords = {{Cerebellar mutism syndrome; Posterior fossa syndrome; Posterior fossa tumour; Secondary resection}},
language = {{eng}},
number = {{4}},
pages = {{747--758}},
publisher = {{Springer}},
series = {{Child's Nervous System}},
title = {{Postoperative speech impairment and cranial nerve deficits after secondary surgery of posterior fossa tumours in childhood : a prospective European multicentre study}},
url = {{http://dx.doi.org/10.1007/s00381-022-05464-0}},
doi = {{10.1007/s00381-022-05464-0}},
volume = {{38}},
year = {{2022}},
}