Second-look surgery after pediatric brain tumor resection – Single center analysis of morbidity and volumetric efficacy

Ann Kristin Schmitz; Christopher Munoz-Bendix; Marc Remke; Triantafyllia Brozou; Arndt Borkhardt; Daniel Hänggi; Thomas Beez

Brain and Spine (Jan 2022)

Second-look surgery after pediatric brain tumor resection – Single center analysis of morbidity and volumetric efficacy

Ann Kristin Schmitz,
Christopher Munoz-Bendix,
Marc Remke,
Triantafyllia Brozou,
Arndt Borkhardt,
Daniel Hänggi,
Thomas Beez

Affiliations

Ann Kristin Schmitz: Department of Neurosurgery, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany; Department of Neurosurgery, Medical Faculty, University of Bonn, Bonn, Germany
Christopher Munoz-Bendix: Department of Neurosurgery, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
Marc Remke: Department of Pediatric Oncology, Hematology and Immunology, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
Triantafyllia Brozou: Department of Pediatric Oncology, Hematology and Immunology, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
Arndt Borkhardt: Department of Pediatric Oncology, Hematology and Immunology, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
Daniel Hänggi: Department of Neurosurgery, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
Thomas Beez: Department of Neurosurgery, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany; Corresponding author. Department of Neurosurgery, Medical Faculty, Heinrich-Heine-University, Moorenstrasse 5, 40225, Düsseldorf, Germany.

Journal volume & issue: Vol. 2
p. 100865

Abstract

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Introduction: Postoperative residual tumor can occur for intentional or unintentional reasons. Decision-making regarding second-look surgery has to weigh molecular biology, probability of total resection and prognostic relevance against potential additional morbidity. In interdisciplinary tumor boards the neurosurgeon has to estimate risk and efficacy of second-look surgery in individual cases, based on precise data. Research question: Aim of this study was to provide such data by analyzing morbidity and volumetric efficacy of second-look surgery at a designated pediatric neuro-oncology unit. Material and methods: Children who received second-look surgery in 2007–2018 after incomplete resections were analyzed retrospectively. Measurements were performed on early postoperative magnetic resonance imaging, comparing axial diameter-based measurement as well as computer-assisted volumetric analysis. Results: 59 patients (37% of the overall cohort; 21 female; mean age: 8 ± 5 years) received a subtotal (n = 35) or near total (n = 24) resection. After interdisciplinary case review, 12 of these patients received second-look surgery mainly for residual ependymoma. This led to further tumor volume reduction in all cases (new degrees of resection: subtotal = 2, near total = 6, gross total = 4). No new permanent morbidity or perioperative mortality was observed. Discussion and conclusion: Second-look surgery did not increase mortality and permanent morbidity, had an 8% rate of transient morbidity and achieved tumor volume reduction above 95% in 75% of selected cases, with 4 additional gross total resections. Second-look surgery is safe and effective with regard to volumetric outcome parameters even in cases with good initial resections, although the role of second-look surgery regarding oncological outcome has to be further investigated in times of personalized molecular medicine.

Published in Brain and Spine

ISSN: 2772-5294 (Online)
Publisher: Elsevier
Country of publisher: Netherlands
LCC subjects: Medicine: Internal medicine: Neurosciences. Biological psychiatry. Neuropsychiatry: Neurology. Diseases of the nervous system
Website: https://www.journals.elsevier.com/brain-and-spine

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