Postoperative speech impairment and cranial nerve deficits after secondary surgery of posterior fossa tumours in childhood: a prospective European multicentre study
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Postoperative speech impairment and cranial nerve deficits after secondary surgery of posterior fossa tumours in childhood : a prospective European multicentre study. / Grønbæk, J. Kjær; Toescu, S.; Frič, R.; Nilsson, P.; Castor, C.; Mallucci, C.; Pizer, B.; Aquilina, K.; Molinari, E.; Hjort, M. Aasved; Karppinen, A.; Rutkauskiene, G.; Mudra, K.; Markia, B.; van Baarsen, K.; Hoving, E.; Zipfel, J.; Wibroe, M.; Nysom, K.; Schmiegelow, K.; Sehested, A.; Mathiasen, R.; Juhler, M.; CMS study group.
I: Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery, Bind 38, Nr. 4, 2022, s. 747-758.Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
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TY - JOUR
T1 - Postoperative speech impairment and cranial nerve deficits after secondary surgery of posterior fossa tumours in childhood
T2 - a prospective European multicentre study
AU - Grønbæk, J. Kjær
AU - Toescu, S.
AU - Frič, R.
AU - Nilsson, P.
AU - Castor, C.
AU - Mallucci, C.
AU - Pizer, B.
AU - Aquilina, K.
AU - Molinari, E.
AU - Hjort, M. Aasved
AU - Karppinen, A.
AU - Rutkauskiene, G.
AU - Mudra, K.
AU - Markia, B.
AU - van Baarsen, K.
AU - Hoving, E.
AU - Zipfel, J.
AU - Wibroe, M.
AU - Nysom, K.
AU - Schmiegelow, K.
AU - Sehested, A.
AU - Mathiasen, R.
AU - Juhler, M.
AU - CMS study group
N1 - Publisher Copyright: © 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.
PY - 2022
Y1 - 2022
N2 - 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.
AB - 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.
KW - Cerebellar mutism syndrome
KW - Posterior fossa syndrome
KW - Posterior fossa tumour
KW - Secondary resection
U2 - 10.1007/s00381-022-05464-0
DO - 10.1007/s00381-022-05464-0
M3 - Journal article
C2 - 35157109
AN - SCOPUS:85127999822
VL - 38
SP - 747
EP - 758
JO - Child's Nervous System
JF - Child's Nervous System
SN - 0256-7040
IS - 4
ER -
ID: 303801177