Medulloblastoma Operative and Postoperative Complications in Baghdad Anwer Noori Hafidh FICM, Haider Faris Alwash FIBMS, Tayseer Hamid Shakir BSc
Abstract
ABSTRACT Background: Medulloblastoma is one of the most common posterior fossa tumors in childhood, most frequently found in the region of the 4th ventricle, adherent to the inferior medullary velum in the midline. The surgery related complications as well as outcome of medulloblastoma still remain a major challenge.
Objective: To clarify and detect the main perioperative complications of medulloblastoma, and to know the factors that lead to them. Then to determine the methods that can minimize the complications as much as possible.
Methods: This is a case series study conducted at the Neurosurgical Hospitals in Baghdad, between January to December 2014, on 39 patients with histopathologically proven as medulloblastoma. Clinical data was collected including symptoms and signs, in addition to assessment of radiological picture. Data regarding management of the patient including the dealing with hydrocephalus, and the definitive surgery of suboccipital craniectomy starting from anesthesia, positioning, surgical techniques, ending with postoperative care and follow up within 72 hours was recorded. After that analyzing of the correlations of these data to the intraoperative, immediate and early postoperative complications was done.
Results: The most common affected age group was between 5-7 years. Male to female ratio was (2.7-1). Hydrocephalus presented in 94% of patients, and 87% of the tumors were vermian. Ventriculoperitoneal (VP) shunts before definitive surgery was done for 94.8% of the patients. Sitting position was used in 77% of patients and prone in 23%. All patients were operated on by suboccipital craniectomy, gross total resection of the tumor was done in 56%, subtotal resection was done in 36%, while 8% partial resection was done. Bradycardia and arrhythmia was the most common intraoperative complication, followed by cerebellar herniation. The most common postoperative complications were cerebellar dysfunction (20%), cranial nerve injury (16%), and mutism (10%).
Conclusion: Gross total removal of tumor should be the gold standard of neurosurgeon. Midline, classical type, vascular and brain stem violating medulloblastomas are associated with more perioperative complications. Brain stem violation was the main factor that affects the outcome
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