Predictive Factors for the Occurrence of Perioperative Complications in Pediatric Posterior Fossa Tumors

-OBJECTIVE: Central nervous system tumors are the most common solid neoplasm in children, 60%-70% occurring in the posterior fossa. Surgery is the mainstay of treatment but surgery in the pediatric population is associated with a high risk of perioperative complications. We aimed at analyzing the perioperative complications after posterior fossa surgery in a pediatric population and identifying the associated risk factors.-METHODS: Retrospective study of all pediatric patients -ndergoing surgery for resection of a posterior fossa tumor between 1999 and 2019, at the University Hospital of Lausanne. Data were collected including age, clinical presenta-tion, tumor localization, presence of preoperative hydro-cephalus, timing of surgery, surgical approach, surgical team, extent of surgical resection, perisurgical compli-cations, and histopathological diagnosis. Statistical analysis was performed to correlate the data with the risk of complications.-RESULTS: Sixty-seven patients were included. Perisur-gical complications were identified in 39 patients (58.2%), of which 14 (35.9%) required corrective interventions. The perioperative mortality rate was zero. In the univariate analysis, surgery performed under emergency conditions, transvermian and telovelar approaches were statistically correlated with an increased rate of complications. Extent of resection, hydrocephalus, and Lansky index at presen-tation were not predictive of perioperative complications. Midline tumor, tumor volume >25 cm3, and surgery per-formed by a nonspecialized pediatric onconeurosurgeon were found to be independent risk factors in the multi-variate analysis.-CONCLUSIONS: Surgery in the posterior fossa in the pediatric population harbors a high risk of complications. Identifying the variables contributing to these complica-tions is important in order to improve surgical management of these patients.

Automated summary

This study aimed to analyze perioperative complications after posterior fossa surgery in pediatric patients and identify associated risk factors. The results showed that emergency surgery, transvermian and telovelar approaches, midline tumor, tumor volume >25 cm3, and surgery performed by a nonspecialized pediatric onconeurosurgeon were independent risk factors for complications.