Article
Minimally invasive neurosurgery in pediatric patients – A review of 109 surgeries: Clinical history and operative results
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Authors
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Mirjam Renovanz
- Klinik und Poliklinik für Neurochirurgie, Universitätsmedizin Mainz, Mainz
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Anne-Katrin Hickmann
- Neurochirurgische Klinik, Klinikum Stuttgart, Katharinenhospital, Stuttgart
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Markus Bittl
- Neurochirurgische Klinik, Klinikum Stuttgart, Katharinenhospital, Stuttgart
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Nikolai J. Hopf
- Neurochirurgische Klinik, Klinikum Stuttgart, Katharinenhospital, Stuttgart
| Published: | May 21, 2013 |
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Outline
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Objective: Surgery is an integral component and typically the first line of therapy for children with central nervous system tumors. Conventional aims of neurosurgery including tumor removal, management of hydrocephalus and diagnostic sampling have been radically modified with innovative technologies such as navigational guidance, functional mapping, endoscopic surgery, second-look surgery and physiologic imaging. The aim of the study was to investigate our operative results using minimally invasive technique in children with brain tumors.
Method: Our database was retrospectively searched for children who have been treated with central nervous system tumors. Clinical features, surgical technique and results, length of hospital stay and complications were reviewed. Pre- and early postoperative MRI were evaluated for degree of surgical resection. Correlation of tumor localization, length of hospital stay as well as surgical techniques and clinical outcome was investigated.
Results: 105 patients underwent 109 tumor resections using minimally invasive approaches (image- and functional guided tailored keyhole approaches for supratentorial, retrosigmoid and suboccipital keyhole approaches for infratentorial lesions). Most tumors were located supratentorially (76%). Gliomas were diagnosed in 38% of cases, ependymomas in 8%, and medulloblastomas in 5%. The main presenting symptoms were headache combined with nausea and vomiting (31%), seizures (17%) and cerebellar symptoms (8%). In 68% neurologic improvement was documented postoperatively. In 7% hemiparesis increased and 12% of the patients showed cranial nerve irritation postoperatively. Gross total resection (resection ≥ 95%) was achieved in 66%. The most common complication was CSF fistula (n=8, surgical revision: n=5). Mean length of hospital stay was 8.2 days. 41 patients stayed more than 7 days of which 43% underwent suboccipital craniotomy.
Conclusions: This study shows that it is possible to achieve surgical results comparable to those in the adult population applying minimal invasive techniques. Beside the primary goal of optimal clinical outcome, a good cosmetic result and fast recovery is also of great importance to this patient group. Minimally invasive technique is suitable to enable both.
