Evaluation of the Post-Operatory Period in Neurosurgical Pediatric Patients with Central Nervous Sistem Tumor: A Single General Center Experience

Background/Objectives: Morbidity following tumor surgery is greater than other types of neurosurgery. Accurate data col- lection allows comparison between institutions and quality improvement. The aim was to analyze the 30-day or inpatient outcome of pediatric patients with central nervous system (CNS) tumors in terms of significant adverse events (SAE) in our general institution in the post-operatory (PO) period. Design/Methods: AE of children 0-16 years operated at our institution (2009-2018) for CNS tumors were prospec- tively registered and retrospectively analyzed with consensus definitions. Results: Seventy-eight procedures were performed in 65 patients (54% male, mean age 9.1 years). Tumors were supratentorial in 59% children and Astrocytic tumor was the most frequent diagnosis (55%). Fifty-eight percent underwent gross total resection, 31% partial removal and 11% biopsy. Six percent developed Hydrocephalus in the PO period, 5% maior CSF-leakage and 8% pseudomeningocele. Nineteen percent developed new moderate-severe neurological deficits (73% infraterorial tumors), 5% seizures and 6.4% a CNS infection. We recorded 5 ischemic events (6.4%) but no hemorrhages. Mortality was 0% while 30.1% procedures were linked to at least one SAE; in these children the mean Hospital and ICU length of stay were significantly longer (p< 0.00001-p<0.005). Using a logistic regression model we found no association with sex (p=0.17), age at the onset (p=0.21) and histology (p=0.19) while we found that total resection had a 79% lower risk (OR=0.21; 95%CI=0.06- 0.68) of SAE in comparison with partial removal-biopsy (p=0.009) and that sovratentorial tumors had a 87% lower risk (OR=0.13; 95%CI=0.03-0.49) of SAE in comparison with infratentorial-spinal tumors (p=0.003). Conclusions: SAE rate in a general tertiary hospital is high but comparable to pubblished data of international pediatric institutions. Recognition of adverse events is fundamental for appropriate patient management and could affect long term outcome therefore continuous surveillance is needed. Infratentorial and not completely resectable tumors are inde- pendent risk factors for SAE.