Correlation of neurosurgical subspecialization with outcomes in children with malignant brain tumors

OBJECTIVE: This study was performed to evaluate the association between the type of neurosurgeon (general or pediatric) and either the extent of tumor removal or the frequency of complications in children undergoing malignant brain tumor resections. METHODS: Data were analyzed from three recent Children's Cancer Group studi es: two on medulloblastomas/primitive neuroectodermal tumors and one on mal ignant gliomas. Neurosurgeons were classified as general neurosurgeons, as designated pediatric neurosurgeons in their institutions, or as members of the American Society of Pediatric Neurosurgeons (ASPN), which requires pedi atric neurosurgical experience and practice standards. RESULTS: Data forms from 732 children were analyzed; 485 were from children with medulloblastomas/primitive neuroectodermal tumors, and 247 were from children with malignant gliomas. Operations were performed by 269 neurosurg eons, including 213 general neurosurgeons, 29 designated pediatric neurosur geons, and 27 ASPN members. The mean number of operations per surgeon was 1 .8, 4.9, and 7.6 for general neurosurgeons, designated pediatric neurosurge ons, and ASPN members, respectively. There was a significant relationship b etween the extent of tumor resection or the amount of residual tumor and th e type of neurosurgeon. Designated pediatric neurosurgeons and ASPN members were more likely to remove more than 90% of the tumor and to leave less th an 1.5 cc of residual tumor than were general neurosurgeons (P < 0.05). In these studies, the probability of extensive tumor removal correlated with t he number of operations the neurosurgeon performed (P < 0.01). Neurological complications occurred in the following proportion of cases: general neuro surgeons, 23%; designated pediatric neurosurgeons, 32%; and ASPN members, 1 8%. CONCLUSION: Pediatric neurosurgeons are more likely than general neurosurge ons to extensively remove malignant pediatric brain tumors. In these tumors , extent of removal has been demonstrated to influence survival.