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The growth pattern of medulloblastoma affects short-term neurological impairments after surgery: results from the prospective multi-center HIT-SIOP PNET 4 study

The growth pattern of medulloblastoma affects short-term neurological impairments after surgery: results from the prospective multi-center HIT-SIOP PNET 4 study
The growth pattern of medulloblastoma affects short-term neurological impairments after surgery: results from the prospective multi-center HIT-SIOP PNET 4 study
Objective: extensive resection of a tumor in the posterior fossa in children is associated with risk of neurological deficits. The objective of this study was to prospectively evaluate the short-term neurological morbidity in children after medulloblastoma (MB) surgery and relate this to the tumor´s growth pattern and to the extent of resection.

Methods: in 160 patients taking part in the HIT-SIOP PNET 4 trial neurosurgeons prospectively responded to questions concerning the growth pattern of the tumor they had operated on. The extent of resection, i.e. gross-, near- or sub-total, was evaluated by MRI. The patients’ neurological status before resection and around 30 days after resection was recorded.

Results: invasive tumor growth, defined as local invasion in the brain or meninges, in a cranial nerve or major vessel, was reported in 58% of the patients. After surgery almost 70% of all patients were affected by one or several neurological impairments e.g. impaired vision, impaired extraocular movements and ataxia. However, this figure was very similar to the preoperative findings. Invasive tumor growth implied a significantly higher number of impairments after surgery (p=0.03) as well as deterioration regarding extraocular movements, facial weakness (p= 0.012, 0.048) and ataxia in arms and trunk (p= 0.014, 0.025) compared to non-invasive tumor growth. This deterioration was not dependent on the extent of resection performed. PFS at 5 years was 80±4% and 76±5%, respectively, for patients with invasive and non-invasive tumor growth with no difference in the 5 years PFS for extent of resection.

Conclusions: preoperative neurological impairments and invasive tumor growth were strong predictors for deterioration in short-term neurological outcome after MB neurosurgery whereas the extent of resection was not. Neither tumor invasiveness nor extent of resection influenced PFS. These findings support to continue maximal safe resection in MB surgery where functional risks are not taken in areas with tumor invasion.
CMS, Cerebellar mutism syndrome, Growth pattern, Medulloblastoma, Neurological sequelae, Oncology, Pediatric neurosurgery, Resection
1933-0707
425-433
Kennedy, Colin
7c3aff62-0a86-4b44-b7d7-4bc01f23ec93
Schepke, Elizabeth
429e3587-166d-430f-9363-ae7ef50022f0
Kennedy, Colin
7c3aff62-0a86-4b44-b7d7-4bc01f23ec93
Schepke, Elizabeth
429e3587-166d-430f-9363-ae7ef50022f0

Kennedy, Colin and Schepke, Elizabeth (2020) The growth pattern of medulloblastoma affects short-term neurological impairments after surgery: results from the prospective multi-center HIT-SIOP PNET 4 study. Journal of Neurosurgery: Pediatrics, 25 (4), 425-433. (doi:10.3171/2019.11.PEDS19349).

Record type: Article

Abstract

Objective: extensive resection of a tumor in the posterior fossa in children is associated with risk of neurological deficits. The objective of this study was to prospectively evaluate the short-term neurological morbidity in children after medulloblastoma (MB) surgery and relate this to the tumor´s growth pattern and to the extent of resection.

Methods: in 160 patients taking part in the HIT-SIOP PNET 4 trial neurosurgeons prospectively responded to questions concerning the growth pattern of the tumor they had operated on. The extent of resection, i.e. gross-, near- or sub-total, was evaluated by MRI. The patients’ neurological status before resection and around 30 days after resection was recorded.

Results: invasive tumor growth, defined as local invasion in the brain or meninges, in a cranial nerve or major vessel, was reported in 58% of the patients. After surgery almost 70% of all patients were affected by one or several neurological impairments e.g. impaired vision, impaired extraocular movements and ataxia. However, this figure was very similar to the preoperative findings. Invasive tumor growth implied a significantly higher number of impairments after surgery (p=0.03) as well as deterioration regarding extraocular movements, facial weakness (p= 0.012, 0.048) and ataxia in arms and trunk (p= 0.014, 0.025) compared to non-invasive tumor growth. This deterioration was not dependent on the extent of resection performed. PFS at 5 years was 80±4% and 76±5%, respectively, for patients with invasive and non-invasive tumor growth with no difference in the 5 years PFS for extent of resection.

Conclusions: preoperative neurological impairments and invasive tumor growth were strong predictors for deterioration in short-term neurological outcome after MB neurosurgery whereas the extent of resection was not. Neither tumor invasiveness nor extent of resection influenced PFS. These findings support to continue maximal safe resection in MB surgery where functional risks are not taken in areas with tumor invasion.

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Accepted/In Press date: 1 November 2019
e-pub ahead of print date: 17 January 2020
Keywords: CMS, Cerebellar mutism syndrome, Growth pattern, Medulloblastoma, Neurological sequelae, Oncology, Pediatric neurosurgery, Resection

Identifiers

Local EPrints ID: 436792
URI: http://eprints.soton.ac.uk/id/eprint/436792
ISSN: 1933-0707
PURE UUID: 1fe69640-c901-42a9-8947-38b5fe0f5180

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Date deposited: 09 Jan 2020 17:30
Last modified: 21 Nov 2021 19:16

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Author: Colin Kennedy
Author: Elizabeth Schepke

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