Neurosurgical morbidity in pediatric supratentorial midline low‐grade glioma: Results from the German LGG studies

• Published in: International journal of cancer Vol. 153; no. 8; pp. 1487 - 1500
• Main Authors: Weiß, Sarah, Thomale, Ulrich‐Wilhelm, Schulz, Matthias, Kandels, Daniela, Schuhmann, Martin U., El Damaty, Ahmed, Krauss, Juergen, Driever, Pablo Hernáiz, Witt, Olaf, Bison, Brigitte, Pietsch, Torsten, Gnekow, Astrid, Simon, Michèle
• Format: Journal Article
• Language: English
• Published: Hoboken, USA John Wiley & Sons, Inc 15-10-2023; Wiley Subscription Services, Inc
• Subjects: Biopsy; Cancer; child; complication; Glioma; Hydrocephalus; low‐grade glioma; Medical research; Morbidity; Neurological diseases; Neurosurgery; neuro‐surgery; Patients; Pediatrics; Risk factors; supratentorial midline; Surgery; Tumors; complication; low-grade glioma; neuro-surgery; morbidity; supratentorial midline; child
• ISSN: 0020-7136; 1097-0215
• DOI: 10.1002/ijc.34615

Surgical resection is a mainstay of treatment for pediatric low‐grade glioma (LGG) within all current therapy algorithms, yet associated morbidity is scarcely reported. As supratentorial midline (SML) interventions are particularly challenging, we investigated the frequency of neurosurgical complications/new impairments aiming to identify their risk factors. Records were retrospectively analyzed from 318 patients with SML‐LGG from successive German multicenter LGG studies, undergoing surgery between May 1998 and June 2020. Exactly 537 operations (230 resections, 167 biopsies, 140 nontumor procedures) were performed in 318 patients (54% male, median age: 7.6 years at diagnosis, 9.5 years at operation, 11% NF1, 42.5% optic pathway glioma). Surgical mortality rate was 0.93%. Applying the Drake classification, postoperative surgical morbidity was observed following 254/537 (47.3%) and medical morbidity following 97/537 (18.1%) patients with a 40.1% 30‐day persistence rate for newly developed neurological deficits (65/162). Neuroendocrine impairment affected 53/318 patients (16.7%), visual deterioration 34/318 (10.7%). Postsurgical morbidity was associated with patient age <3 years at operation, tumor volume ≥80 cm3, presence of hydrocephalus, complete resection, surgery in centers with less than median reported tumor‐related procedures and during the earlier study period between 1998 and 2006, while the neurosurgical approach, tumor location, NF1 status or previous nonsurgical treatment were not. Neurosurgery‐associated morbidity was frequent in pediatric patients with SML‐LGG undergoing surgery in the German LGG‐studies. We identified patient‐ and institution‐associated factors that may increase the risk for complications. We advocate that local multidisciplinary teams consider the planned extent of resection and surgical skills.
What's new?
Pediatric low‐grade gliomas (LGGs) may be associated with high morbidity, despite excellent long‐term survival. In particular, LGG along the supratentorial midline (SML) represents a challenging site for intervention, with very rare reporting of neurosurgical complications. Here, the authors analyzed interventions and postsurgical periods in German SML‐LGG patients. Postsurgical morbidity was frequent among patients age 3 years or younger and among patients with larger tumor volume and hydrocephalus. Other factors associated with neurosurgical morbidity included complete resection and surgery at institutions where interventions for SML‐LGG were carried out less often. The findings highlight areas for consideration in reducing neurosurgical complications in SML‐LGG.