THE SURGICAL AND NATURAL MORBIDITY OF AGGRESSIVE RESECTION FOR POSTERIOR-FOSSA TUMORS IN CHILDHOOD

The morbidity associated with gross total removal of pediatric posteri or fossa tumors is well recognized although it is rarely isolated from other factors that comprise the management morbidity for these tumors . This study reviews (1) the operative and postoperative complications in 105 patients and (2) the neurological morbidity in a subset of 91 patients undergoing gross total removal of their tumor between 1982 an d 1992. Gross total removal was achieved in 102 patients with a single procedure. Two patients with residual tumor underwent early repeat cr aniotomy for excision and I is being followed without repeat resection . Intra- and postoperative complications occurred in 33 patients and i ncluded hematoma requiring craniotomy (3), gastrointestinal hemorrhage (2), hydrocephalus requiring shunt placement (9), wound problems (4), and pseudomeningocele formation requiring additional treatment (5). D elayed onset hydrocephalus requiring shunting occurred in 2 patients a nd spinal deformity in 4 patients. Worsening of preoperative deficit ( new cranial nerve palsies, worsening ataxia, bulbar dysfunction includ ing apnea, mutism and seizures) occurred in 41% of patients operated o n for primitive neuroectodermal tumors (PNET) (14/34), 53% of ependymo mas (10/19), and 30% of astrocytomas (15/50). No patient who had a cho roid plexus tumor was worsened by the procedure. Complete recovery of new postoperative deficits occurred in 14% of PNET (2/14), 50% of epen dymoma (5/10) and 47% of astrocytoma (7/15), most often within 6 month s of the procedure. Residual neurological morbidity, due to persistenc e of preoperative symptoms or due to deficits that occurred as the res ult of the surgical procedure, was assessed in a subgroup of 91 patien ts followed for an average of 48 months (2-147 months). This assessmen t did not include morbidity due to adjuvant therapy. Sixty-two percent of patients continued to exhibit abnormal cerebellar or bulbar signs. Forty-three percent of the total population exhibited limitation in f unction due to residual deficit. Only 38% of patients were both functi onally normal and had a normal neurological examination at last follow -up.