Anesthesia for intracranial surgery in infants and children

Preoperative coagulopathy and blood transfusion requirements in children with intraventricular lesions undergoing neurosurgery: a retrospective cohort study

PURPOSE

Pediatric patients undergoing neurosurgery pose risk of perioperative hemorrhage and clotting dysfunction which is increased in tumors with high vascularity, endothelial exposure, and necrosis. Lesions affecting the ventricular system may arise from several etiologies, including rare tumors. The present study aimed to study the preoperative coagulation and transfusion profile of pediatric patients undergoing neurosurgery for intraventricular lesions.

METHODS

A retrospective study of all paediatric patients who underwent surgery for intraventricular lesion was included from June 2014 to June 2022. Demographic data, preoperative and postoperative investigations, intraoperative blood loss, blood product transfusion, and duration of surgery were noted. Postoperative outcomes were also assessed.

RESULTS

A total of 98 patients underwent surgery, the median age was 11.1 years (1.0 to 17.0), with a male predominance (50.9%). The median blood loss during surgery was 500 mL (300-812.5). The incidence of preoperative coagulopathy was 30.7%. The intraoperative packed blood cell and fresh frozen plasma transfusion requirement was noted in 50.9% and 5%, respectively. The median ICU stay and hospital stay was 6 days (3-10) and 14 days (4-77), respectively. The mortality rate in the study population was 7.7%.

CONCLUSION

This study highlights the multifactorial nature of perioperative blood loss and transfusion requirements in pediatric patients undergoing surgery for intraventricular lesions. Factors such as tumor histopathology, preoperative hemoglobin levels, and surgical duration play a crucial role in determining transfusion needs.

Essential Management of Pediatric Brain Tumors

Brain tumors are the most common solid tumors in children and are associated with high mortality. The most common childhood brain tumors are grouped as low-grade gliomas (LGG), high grade gliomas (HGG), ependymomas, and embryonal tumors, according to the World Health Organization (WHO). Advances in molecular genetics have led to a shift from pure histopathological diagnosis to integrated diagnosis. For the first time, these new criteria were included in the WHO classification published in 2016 and has been further updated in the 2021 edition. Integrated diagnosis is based on molecular genomic similarities of the tumor subclasses, and it can better explain the differences in clinical courses of previously histopathologically identical entities. Important advances have also been made in pediatric neuro-oncology. A growing understanding of the molecular-genetic background of tumorigenesis has improved the diagnostic accuracy. Re-stratification of treatment protocols and the development of targeted therapies will significantly affect overall survival and quality of life. For some pediatric tumors, these advances have significantly improved therapeutic management and prognosis in certain tumor subgroups. Some therapeutic approaches also have serious long-term consequences. Therefore, optimized treatments are greatly needed. Here, we discuss the importance of multidisciplinary collaboration and the role of (pediatric) neurosurgery by briefly describing the most common childhood brain tumors and their currently recognized molecular subgroups.

Perioperative Factors Affecting Neurologic Outcome in Infants Undergoing Surgery for Intracranial Lesion: A Retrospective Study

BACKGROUND

The short-term neurologic outcome of infants undergoing brain tumor surgery depends on various perioperative factors. This study was undertaken to analyze the effects of perioperative variables on the postoperative neurologic outcome in infants undergoing brain tumor surgery.

METHODS

We retrospectively reviewed the chart of infants undergoing craniotomy for brain tumor removal from 2000 to 2017. The data related to preoperative variables, intraoperative management details, and postoperative factors were collected and analyzed. The primary outcome measure was occurrence of new postoperative neurologic deficit (POND) and the secondary outcome measure was length of hospital stay (LOHS).

RESULTS

Complete data were available for 40 infants undergoing craniotomy for excision of intracranial tumor. New-onset POND was found in 14 infants (35%). Based on logistic regression analysis, POND was associated with use of mannitol and massive blood transfusion (MBT) trended toward significance. Based on linear regression analysis, the risk factor associated with prolonged LOHS was reintubation and POND trended toward significance.

CONCLUSIONS

In this study, factors associated with new POND were mannitol use and to a certain extent MBT. The variables associated with prolonged LOHS were reintubation and to a certain extent POND. The anesthetic technique, location of tumor, tumor histology, and extent of tumor resection did not influence the occurrence of new POND or prolonged LOHS in infantile intracranial tumor surgery. Further prospective studies with larger samples are required for confirmation of these findings and identification of new perioperative risk factors.