ObjectivesTo measure complications of paediatric neurooncology surgery using the Clavien Dindo grading scale, and identify predictors of surgical morbidity.DesignRetrospective review of prospectively collected data.SubjectsAll paediatric patients treated with craniotomy for excision of intracranial tumour between 2008 and 2017 in a single tertiary paediatric neurosurgery centre.MethodsDemographics, surgical details and perioperative complications were prospectively recorded between 0 and 30 days post operatively. These were retrospectively graded using the CD scale. Data analysis was done in R using logistic regression. Significance was defined as p<0.05ResultsBetween 3/1/2008 and 21/12/2017 there were 322 operations, on 254 patients (142 Male). Median age at surgery was 9 years (IQR 4–13 years). 48% were without complication on the CD scale. Maximum CD grade complication for each procedure was 1 in 11%, 2 in 19%, 3A in 2%, 3B in 14%, and 4 in 0.6% of operations. 30 day mortality was 0.9%. CD grade of 3B or over was associated with infratentorial tumours (OR 2.24; CI 1.10–4.68; p=0.004) and WHO grade III tumours (OR 4.12; CI 1.56–10.86; p=0.028).ConclusionsComplications in paediatric neurooncology surgery are common overall, but our results are favourable in comparison to the literature. The CD scale has limitations in neurosurgery but gives insight into the health economic impact of complications. Infratentorial tumours, and WHO grade III tumours were associated with increased morbidity.
ObjectivesPrimary spinal tumours in children are rare and poorly understood; we review 10 years of surgical experience.DesignRetrospective review of prospectively maintained database.SubjectsChildren receiving surgical management of primary spinal tumours in a single, tertiary paediatric neurosurgery centre.MethodsOperations for primary spinal tumours were abstracted from our prospectively maintained surgical database and supplemented with data from case notes, operative records, and imaging studies.ResultsBetween 2008 and 2017, 37 procedures were performed on 29 patients (19 male; Median age 7.5 years, IQR 2–11.25). 28 had their primary procedure in our unit: 21 excisions, and 7 biopsies (of which 5 proceeded to further surgery). Tumours were classified as extradural (10), intradural extramedullary (3), intradural intramedullary (11) or bony (4). Tumours were found at the following levels: Cervical (8; 29%), Cervicothoracic (2; 7.1%), Thoracic (10; 36%), Thoracolumbar (3; 11%), Lumbar (2; 7.1%), Lumbosacral (2; 7.1%) and Sacral (1; 3.6%). Histology comprised: Pilocytic Astrocytoma (6), Other Astrocytoma (4), Schwannoma (3), Ewing Sarcoma (2), Langerhans cell histiocytosis (2), Lymphoma (2), Neurofibroma (2), and others (7) including one Myxopapillary Ependymoma.ConclusionsThe rarity and heterogeneity of paediatric spinal tumours makes treatment challenging. We propose a national online registry including a tissue bank, and invite collaboration with other units.
ObjectivesNeurovascular disorders are uncommon, complex conditions in children. We reviewed the screening practice and outcome of children referred to the neurovascular service on the basis of positive family history.DesignRetrospective review of prospectively maintained database.SubjectsChildren referred to the neurovascular service on the basis of family history, for screening at our hospital.MethodsWe retrospectively examined our database between July 2008 and April 2018 for the reasons for referral, family history, investigations performed, and the outcome of the screening process.Results44 children were reviewed (23 male, median age 10). Thirty-one children had an MRI/MRA brain. One child subsequently had uncomplicated digital subtraction angiography. Thirty children were referred due to a family history of subarachnoid haemorrhage, of which 17 had a single first-degree relative, and two had two first-degree relatives. Nine children were referred with a family history of arteriovenous malformation, (2 were associated with hereditary haemorrhagic telangiectasia). Five children were discussed due to a family history of non-specific haemorrhagic stroke. Seven children had a history of headache, (4 were prescribed Pizotifen for migraine). No neurovascular pathology was detected following screening within our cohort.ConclusionsA consensus screening policy does not exist but is required both to guide clinical practice and to assuage parental or patient concerns. We will survey UK paediatric centres to commence this process.
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