Ten-year institutional review of infratentorial pediatric brain tumors from LMIC

Abstract

Abstract PURPOSE: Brain tumors constitute 15–20% of all childhood cancers, whereas infratentorial brain tumors make up around 60–75% of all intracranial tumors. Surgical resection of infratentorial pediatric brain tumors carries a cumulative morbidity risk of up to 30%. We aimed to retrospectively review and analyze the clinical and functional outcomes of all infratentorial brain tumors where resections had been performed at a tertiary care hospital in Karachi Pakistan, for 10 years. METHODS: It was a retrospective cohort study, conducted at the Aga Khan University Hospital. All patients aged 0–18 years, who underwent resection for infratentorial brain tumors between January 2009 and December 2019 were analysed. The patients were identified using ICD-10 codes, and files were then reviewed for demographics, clinical presentations, details of the surgery, pre-operative and post-operative functional status, and different complications. MRI scans of patients were reviewed from the online hospital management system. Lansky's score was used to record functional status. Patients with incomplete medical records were excluded. RESULTS: Ninety-two children were included in the study. The median age was 6 years (IQR: 4–12 years), out of which 55 (59.8%) were male and 37 (40.2%) were female patients. Most common presenting complaint was headache (n = 68, 73.9%). The fourth ventricle was the most common location (43; 46.7%), and the majority of patients had medulloblastoma on histopathology (36; 39.1%). Gross total resection was achieved in 41 (44.6%) cases, followed by maximum safe resection in 28 (30.4%) cases, whereas 23 (25%) patients only had a biopsy. The mean post-op Lansky score (65.76) was better than the mean pre-op Lansky score (55.76) by 10 points and this difference was statistically significant < 0.001. Patients who had undergone only a biopsy (> 90% residual) were associated with poor outcomes (p = 0.014). CONCLUSION: Most of our patients had significant improvement in functional status after surgery, however, a patient who had deterioration in functional status were those who has the significant residual disease after surgery.