VALUTAZIONE DELL’OUTCOME POST-OPERATORIO IN PAZIENTI PEDIATRICI SOTTOPOSTI AD INTERVENTO NEURO-CHIRURGICO PER NEOPLASIA DEL SISTEMA NERVOSO CENTRALE

Purpose: The aim of this study is to analyze the early outcome of the post-operatory (PO) period in terms of significant adverse events rate in neurosurgical pediatric patients with central nervous system tumors (CNS) at our institution, to identify possible risk factors for the occurrence of these events and to compare our results with published data. Materials and methods: We prospectively recorded the PO data of children (0-16 years) with CNS tumors operated on between 2009 and 2018 at our institution and retrospectively reviewed them. We evaluated the occurrence of infections, seizures, hyponatremia, new neurological deficits, hemorrhages, ischemia, and cerebrospinal fluid related complications. We applied the consensus definitions proposed by the Canadian Pediatric Neurosurgery Study Group and by the CDC in order to obtain data comparable with previous studies. In our analysis we considered the adverse events which occurred during the inpatient stay or within 30 days of surgery. Results: We reviewed the PO period of 78 procedures (54% M, mean age 9,1). 58% of children underwent tumor gross total resection, 31% partial removal and 11% a surgical biopsy. The tumor was supratentorial in 59%, infratentorial in 37% and located in the spinal cord in 4%. 73% of patients underwent a first surgical procedure while the rest a reintervention. Astrocytic tumor was the most frequent histological diagnosis (55 %). 6 % of children developed Hydrocephalus, 5 % a maior CSF leakage and 8 % a significant pseudomeningocele. 49 % of children developed fever and 87 % were treated with an antibiotic. in 20 % of procedures the PO period was associated with some kind of infection but only 6 % of children experienced a CNS or shunt infection. 19 % of patients developed a new moderate to severe neurological deficit and seizures occurred in 5 %. We recorded no hemorrhages, 4 % ischemic events and 23 % of patients experienced Hyponatremia but only 4 % a CSWS and 4 % a SIADH. The mortality rate was 0% while 31% of operations were linked to at least one significant adverse event (SAE). On logistic regression analysis we found that radical procedures have a 79 % and supratentorial tumors a 87 % lower risk of SAE in the PO period in comparison with partial removal/biopsy and infratentorial/spinal (p 0,009 and p 0,003). The mean hospital and ICU PO length of stay in procedures linked with at least one SAE was 34.2 days (SD26.6) and 9.5 days (SD 19.3) respectively, which was statistically significantly longer than what we found in procedures with no SAE events (p<0.00001, p<0.005). Conclusions: Our SAE rate in a general tertiary hospital is high but comparable to other important international pediatric institutions using the same system. Earlier recognition of risk factors and post-operatory adverse events is fundamental for patient management and could affect long term outcome. This research will provide useful data to improve the quality of treatments delivered to children with CNS tumors after surgery, continuous surveillance is needed.