Complications After Elective Craniotomy for Tumor Treatment in Pediatric Patients
Overview
This study analyzes postoperative events (POEs) following elective craniotomies for tumor resection in pediatric patients over a 12-year period. It identifies key patient and surgical factors associated with increased risk of both surgical and medical POEs, which significantly impact length of hospital stay and patient outcomes.
Background
Central nervous system tumors are the most common pediatric cancers and the leading cause of cancer-related death in children aged 0–14 in the United States. Surgery, particularly craniotomy, remains a cornerstone of treatment despite advances in medical therapies. Postoperative events, both neurologic and systemic, can adversely affect functional status and quality of life. Prior research has often focused broadly on neurosurgical morbidity or specific tumor types, whereas this study specifically evaluates elective craniotomies for tumor resection and their associated complications.
Data Highlights
The study included all elective craniotomies for tumor resection performed from January 1, 2010, to December 31, 2022, in patients aged 0–21 years at a tertiary care children’s hospital. Key demographic and clinical variables recorded included age groups (0–4, 5–9, ≥10 years), tumor grade (high vs low), presence of shunt-dependent hydrocephalus, prior craniotomy status, and surgeon experience. Postoperative events were tracked within 90 days post-surgery, encompassing both surgical and medical complications requiring intervention.
Key Findings
Postoperative events (POEs) occurred in a significant proportion of pediatric patients undergoing elective craniotomy for tumor, contributing to prolonged hospital length of stay beyond seven days.
Both surgical POEs (e.g., new neurologic deficits, infections, hemorrhage) and medical POEs (e.g., cardiac, respiratory, electrolyte disturbances) were captured, with classification into expected and unexpected events.
Age was analyzed categorically, revealing potential differences in POE risk among infants/toddlers, young children, and older children/young adults.
Surgeon experience influenced outcomes, with the majority of cases performed by two fellowship-trained pediatric neurosurgeons of differing seniority levels.
Preexisting conditions such as shunt-dependent hydrocephalus and prior craniotomy status were important variables associated with POE occurrence.
Only new or worsening postoperative events following the last craniotomy during a hospital admission were considered significant POEs for analysis.
Clinical Implications
Clinicians should recognize that elective craniotomy for tumor resection in pediatric patients carries a substantial risk of both surgical and medical postoperative events, which can extend hospitalization and impact recovery. Careful preoperative assessment of patient factors such as age, tumor grade, and hydrocephalus status, as well as surgical planning by experienced pediatric neurosurgeons, may help mitigate these risks. Vigilant postoperative monitoring for significant POEs within 90 days is essential to optimize outcomes.
Conclusion
Elective craniotomy for tumor treatment in pediatric patients is associated with a notable incidence of postoperative events that affect length of stay and patient recovery. Understanding the relationships between patient characteristics, surgical factors, and POE occurrence can guide clinical decision-making and improve care quality.
References
Central Nervous System Tumors in Children -- Epidemiology and Mortality
Prior Studies on Pediatric Neurosurgical Morbidity
