Neurosurgical Outcomes for Pediatric Central Nervous System Tumors in the United States

Impact of social factors on outcomes following pediatric neuro-oncology surgery in the United States: a systematic review and meta-analysis

To use AI-assisted software to identify gender, racial, and socioeconomic differences in post-operative outcomes following pediatric neuro-oncology surgery. PubMed, Scopus, Web of Science, and Ovid were queried using a semi-automated software. Meta-analyses quantified pooled odds ratios for overall survival (OS), gross total resection (GTR), recurrence, 30-day readmission, medical complications (neurologic and endocrinologic), and surgical complications. Where possible, subanalyses were performed based on study type and cranial tumor location. Sixty-seven studies were included. Across all studies, white children had greater OS (OR 0.70, 95% CI [0.55, 0.88]) and GTR (OR 0.86, 95% CI [0.78, 0.93]), while non-white children more often had a medical complication (OR 1.33, 95% CI [1.01, 1.76]). Those with government insurance (OR 1.72, 95% CI [1.01, 2.92]) or lower household income (OR 1.25, 95% CI [1.10, 1.42]) had higher 30-day readmission rates. Patients treated at a small-volume facility had lower rates (OR 0.80, 95% CI [0.71, 0.91]). Subanalyses of case series showed female patients were at higher risk of endocrinologic complications (OR 2.56, 95% CI [1.17, 5.64]), namely hypopituitarism (OR 3.29, 95% CI [1.10, 9.86]). In cohort studies, female patients more often experienced diabetes insipidus (OR 2.22, 95% CI [1.20, 4.08]). Non-white, government-insured, lower-income, and female patients are more likely to experience an adverse event. This study identifies the importance of considering demographic variables during pre-operative risk assessment. Our findings warrant further subgroup analyses across varying tumor locations and types to elucidate parameters contributing to these disparities and explore interventions.

The association of hospital volume status with treatment and survival outcomes of intracranial meningioma patients: a multivariable analysis of the National Cancer Database

PURPOSE

This study investigates the influence of treatment center volume on survival outcomes and treatment strategies for patients with intracranial meningioma.

METHODS

This is a retrospective cohort study of patients from the National Cancer Database treated for intracranial meningioma from 2004 to 2019. High-volume facility was defined as performing > 45 meningioma procedures/year (top 15%). Logistic regression was used for categorical comparisons. All patients were assessed whether facility volume status was associated with survival outcomes using log-rank tests and a final adjusted Cox proportional hazards model.

RESULTS

181,401 patients were included; 28,325 (15.6%) were treated at high-volume facilities, and 153,076 (84.4%) at low-volume facilities. In adjusted analyses, patients were more likely to be treated at high-volume facilities if they had private insurance status (OR = 1.25, 95% CI 1.21-1.29, p < 0.01) and higher tumor volume (OR = 1.11, 95% CI 1.07-1.14, p < 0.01). Patients treated at high-volume facilities were more likely to receive surgery (OR = 1.43, 95% CI 1.38-1.47, p < 0.01), radiotherapy (OR = 1.5, 95% CI 1.43-1.57, p < 0.01), stereotactic radiosurgery (OR = 1.56, 95% CI 1.48-1.65, p < 0.01), but were less likely to require readmission at 30 days (OR = 0.86, 95% CI 0.79-0.94, p = 0.01). On multivariable analysis, treatment at a high-volume facility was a positive predictor of survival (HR = 0.62, 95% CI 0.55 - 0.70, p < 0.01).

CONCLUSIONS

Most meningiomas are treated at low-volume facilities. Patients treated at high-volume facilities are more likely to receive surgery, radiotherapy, and stereotactic radiosurgery are also more likely to have improved survival when compared to patients treated at low-volume facilities. These findings collectively indicate that patients with lower socioeconomic support may experience worse survival outcomes because they struggle to access care at high-volume facilities. This information should be taken into account when shaping future healthcare policies and designing upcoming multicenter studies on meningioma.

Postoperative complications after central nervous system tumor resection in pediatric patients admitted to an intensive care unit in Colombia

Introduction

Central nervous system (CNS) tumors are the second most prevalent malignant neoplasms in childhood, with surgical resection as the primary therapeutic approach. The immediate postoperative period following CNS tumor resection requires intensive care to mitigate complications associated with high morbidity and mortality.

Objective

The primary aim of this study is to comprehensively describe the postoperative complications observed in pediatric patients who underwent primary CNS tumor resection and were subsequently admitted to the pediatric intensive care unit (PICU) at Hospital Universitario Fundación Valle del Lili in Colombia.

Methods

We conducted a cross-sectional observational analysis of pediatric patients who underwent surgery for CNS tumors and were admitted to our PICU from January 2011 to December 2021. Clinical, histopathologic, and postoperative complication data were collected. A descriptive statistical analysis was performed using measures of dispersion and central tendency with a 95% confidence interval.

Results

A total of 114 patients were included, of whom 55.3% were male. The median PICU stay was 4 days (2-7). The most common tumor type was embryonal (25.4%), followed by low-grade glioma (20.1%) and high-grade glioma (14.9%). Mechanical ventilation was required in 24.5% of patients, with a median extubation time of 3 days (2-9). In the immediate postoperative period, 6.14% of patients experienced CNS hemorrhage and 3.5% experienced intracranial hypertension. Common complications included motor deficits, facial paralysis, and sensory deficits. The mortality rate was 3.5%.

Conclusion

This study describes the postoperative complications, clinical challenges, and interventions observed in pediatric patients after CNS tumor resection in a resource-limited country. Our findings emphasize the importance of tailored interventions and multidisciplinary collaboration to optimize clinical outcomes. Future data comparison from centers sharing similar characteristics will play a crucial role in identifying best practices and enhancing outcomes globally.

Congenital Brain Tumors: Surgical Outcomes and Long-Term Prognostic Factors

OBJECTIVE

To evaluate long-term outcomes of surgical resection for congenital brain tumors (CBTs) in infants under one year of age and to identify factors related to survival.

METHODS

Our retrospective study analyzed infants who underwent gross total or subtotal resection (STR) for CBTs between 2001 and 2019. Data were obtained from medical records, including demographics, clinical presentation, diagnosis, tumor characteristics, and presence of hydrocephalus. Additional factors such as preoperative and/or postoperative ventriculoperitoneal shunt placement and adjuvant chemotherapy or radiotherapy were also reviewed. Cox regression analysis was used to identify factors associated with survival.

RESULTS

The study included 70 patients, with median age at surgery of 198.5 days, and 28 (40%) were girls. Seizures (31.4%) and vomiting (24.3%) were the most common presenting symptoms. High-grade tumors were present in 29 (41.4%) patients. Gross total resection was achieved in 64.3% of cases, with surgical mortality rate of 7.1%. Overall survival rates at 5 and 10 years were 78% and 63%, respectively. Long-term follow-up data were available for 61 patients (87%), with median follow-up of 74.2 months. Among 45 long-term survivors, 55.5% had neurological sequelae. Factors associated with reduced survival included high-grade, preoperative hydrocephalus, larger tumor size, and ventriculoperitoneal shunt placement. The extent of resection improved survival only in low-grade tumor cases. Multivariable Cox regression analysis identified tumor grade and size as independent predictors of poor prognosis.

CONCLUSIONS

Surgical resection remains crucial for treating CBTs in infants under one year, yet the aggressive nature of malignant tumors results in suboptimal outcomes regarding prognosis.

Neurosurgical short-term outcomes for pediatric medulloblastoma patients and molecular correlations: a 10-year single-center observation cohort study

This study examined the risk factors for short-term outcomes, focusing particularly on the associations among molecular subgroups. The analysis focused on the data of pediatric patients with medulloblastoma between 2013 and 2023, as well as operative complications, length of stay from surgery to adjuvant treatment, 30-day unplanned reoperation, unplanned readmission, and mortality. 148 patients were included. Patients with the SHH TP53-wildtype exhibited a lower incidence of complications (45.2% vs. 66.0%, odds ratio [OR] 0.358, 95% confidence interval [CI] 0.160 - 0.802). Female sex (0.437, 0.207 - 0.919) was identified as an independent protective factor for complications, and brainstem involvement (1.900, 1.297 - 2.784) was identified as a risk factor. Surgical time was associated with an increased risk of complications (1.004, 1.001 - 1.008), duration of hospitalization (1.006, 1.003 - 1.010), and reoperation (1.003, 1.001 - 1.006). Age was found to be a predictor of improved outcomes, as each additional year was associated with a 14.1% decrease in the likelihood of experiencing a prolonged length of stay (0.859, 0.772 - 0.956). Patients without metastasis exhibited a reduced risk of reoperation (0.322, 0.133 - 0.784) and readmission (0.208, 0.074 - 0.581). There is a significant degree of variability in the occurrence of operative complications in pediatric patients with medulloblastoma. SHH TP53-wildtype medulloblastoma is commonly correlated with a decreased incidence of complications. The short-term outcomes of patients are influenced by various unmodifiable endogenous factors. These findings could enhance the knowledge of onconeurosurgeons and alleviate the challenges associated with patient/parent education through personalized risk communication. However, the importance of a dedicated center with expertise surgical team and experienced neurosurgeon in improving neurosurgical outcomes appears self-evident.

High-Volume Centers Provide Superior Value of Care in the Surgical Treatment of Malignant Brain Tumor

BACKGROUND

Improved outcomes in surgical patients have been associated with increasing volume of cases. This has led to the development of centers that facilitate care for a specific patient population. This study aimed to evaluate associations of outcomes with hospital characteristics in patients undergoing resection of malignant brain tumors.

METHODS

The 2016-2020 National Inpatient Sample was queried for patients undergoing resection of malignant brain tumors. Teaching hospitals with caseloads >2 standard deviations above the mean (140 cases) were categorized as high-volume centers (HVCs). Value of care was evaluated by adding one point for each of the following: short length of stay, low total charges, favorable discharge disposition, and lack of major comorbidity or complication.

RESULTS

In 3009 hospitals, 118,390 patients underwent resection of malignant brain tumors. HVC criteria were met by 91 (3%) hospitals. HVCs were more likely to treat patients of younger age or higher socioeconomic status (P < 0.01 for all). The Mid-Atlantic and South Atlantic regions had the highest percentage of cases and number of HVCs. Value of care was higher at HVCs (P < 0.01). Care at HVCs was associated with decreased complications (P < 0.01 for all) and improved patient outcomes (P < 0.01 for all).

CONCLUSIONS

Patients undergoing craniotomy for malignant brain neoplasms have superior outcomes in HVCs. Trends of centralization may reflect the benefits of multidisciplinary treatment, geographic preferences, publicity, and cultural impact. Improvement of access to care is an important consideration as this trend continues.