Tumor resection in stages as a strategy for approaching giant intracranial tumors in childhood

Abstract

Abstract Background: Giant pediatric intracranial tumors (GPIT) are associated with high morbidity and mortality and pose a challenge for treatment. This study evaluated the morbimortality-related outcomes of staged resection of GPIT. An observational study was undertaken. Materials and Methods: Twenty children with GPIT were retrospectively evaluated for demographics, clinical presentation, histopathology, weight at first intervention, hemotransfusion rate, weight gain between stages, complications, and survival factors. Non-parametric tests were performed owing to the sample size. The significance level adopted was 5% with a 95% confidence interval. Results: The average age was 3 years and 11 months. Fourteen (70%) patients had tumors in the supratentorial compartment. Thirty-seven interventions were performed with an average weight gain of 1.7 kg between the stages. The most frequent histological types were choroid plexus carcinomas (3), medulloblastomas (3), atypical rhabdoid teratoid tumor (2), and ganglioglioma (2). The mean blood transfusion rate was 28.4 mg/kg. The mean follow-up duration was 19.8 months (range: 1–68 months). Conclusion: The treatment strategy of resecting GPIT in stages proved to be effective in minimizing bleeding, obtaining maximum safe resection, and enabling the patient to recover between procedures. Notably, the degree of malignancy remains the most limiting factor in the survival of these patients.