Intracranial complications of sinogenic and otogenic infections in children: an ESPN survey on their occurrence in the pre-COVID and post-COVID era

BACKGROUND

COVID-19 pandemic is thought to have changed the epidemiology of some pediatric neurosurgical disease: among them are the intracranial complications of sinusitis and otitis (ICSO). According to some studies on a limited number of cases, both streptococci-related sinusitis and ICSO would have increased immediately after the pandemic, although the reason is not clear yet (seasonal changes versus pandemic-related effects). The goal of the present survey of the European Society for Pediatric Neurosurgery (ESPN) was to collect a large number of cases from different European countries encompassing the pre-COVID (2017-2019), COVID (2020-2021), and post-COVID period (2022-June 2023) looking for possible epidemiological and/or clinical changes.

MATERIAL AND METHODS

An English language questionnaire was sent to ESPN members about year of the event, patient's age and gender, presence of immune-deficit or other favoring risk factors, COVID infection, signs and symptoms at onset, site of primary infection, type of intracranial complication, identified germ, type and number of surgical operations, type and duration of medical treatment, clinical and radiological outcome, duration of the follow-up.

RESULTS

Two hundred fifty-four cases were collected by 30 centers coming from 14 different European countries. There was a statistically significant difference between the post-COVID period (129 children, 86 cases/year, 50.7% of the whole series) and the COVID (40 children, 20 cases/year, 15.7%) or the pre-COVID period (85 children, 28.3 cases/year, 33.5%). Other significant differences concerned the presence of predisposing factors/concurrent diseases (higher in the pre-COVID period) and previous COVID infection (higher in the post-COVID period). No relevant differences occurred as far as demographic, microbiological, clinical, radiological, outcome, morbidity, and mortality data were concerned. Paranasal sinuses and middle ear/mastoid were the most involved primary site of infection (71% and 27%, respectively), while extradural or subdural empyema and brain abscess were the most common ICSO (73% and 17%, respectively). Surgery was required in 95% of cases (neurosurgical and ENT procedure in 71% and 62% of cases, respectively) while antibiotics in 99% of cases. After a 12.4-month follow-up, a full clinical and radiological recovery was obtained in 85% and 84% of cases, respectively. The mortality rate was 2.7%.

CONCLUSIONS

These results suggest that the occurrence of ICSO was significantly increased after the pandemic. Such an increase seems to be related to the indirect effects of the pandemic (e.g., immunity debt) rather than to a direct effect of COVID infection or to seasonal fluctuations. ICSO remain challenging diseases but the pandemic did not affect the management strategies nor their prognosis. The epidemiological change of sinusitis/otitis and ICSO should alert about the appropriate follow-up of children with sinusitis/otitis.

P04.02.A Integrated diagnosis and therapeutic decision of pediatric nervous system tumors using a comprehensive genomic profiling test

Background

Nervous system tumors (NST) are one of the leading causes of cancer-related death in children. Next-generation sequencing has enabled the identification of an increasing number of genetic markers, allowing for a more accurate diagnosis, and may help guide clinicians towards a more specific therapeutic approach.

Material and Methods

Retrospective cohort study of pediatric and young adult patients with NST analyzed with FoundationOneHeme® (FOH) panel from March 2020 to April 2021. This panel was requested, in addition to previously performed pathological reviews and routine genetic tests, in order to obtain more accurate diagnoses and/or possible therapeutic targets.

Results

Fifty NST were analyzed with FOH panel, corresponding to 49 patients. Median age at NST diagnosis was 13 years (range 0-23 years); 50% were females. Initial diagnoses were: 10 pilocytic astrocytomas, 10 diffuse gliomas, 5 ependymomas, 6 mixed neuronal-glial tumors, 7 embryonal tumors, 3 meningeal tumors, 5 peripheral nervous system tumors (PNST) and 4 other types of tumors. There was a change in the final integrated diagnosis after performing the FOH panel in 10 patients (1 pilocytic astrocytoma, 3 diffuse gliomas, 4 mixed neuronal-glial tumors and 1 PNST). In thirty patients, at least one possible therapeutic target was identified: in 5 patients the target therapies are approved for the patients’ tumor type; in 20 patients, target therapies are approved for the same mutations in other tumor types; and in 30 patients target therapies are still being evaluated in ongoing clinical trials. After the results of the FOH panel were known, the previous therapeutic approach was changed in 15 patients, but in only 4 this was attributed to the new genomic findings.

Conclusion

Comprehensive genomic profiling tests can improve diagnostic accuracy and allow for a more reliable approach to the management of pediatric patients with nervous system tumors. Although in most patients there was no immediate therapeutic application of the potential targets found, the genomic data obtained could be very useful to patients who may have tumor progressions in the future.