ID #904 Impact Of Brainstem Involvement In Pediatric Posterior Fossa Patients Undergoing Surgery

Introduction Brainstem involvement in pediatric posterior fossa is common finding which is associated with adverse outcomes. We examined our data to look for peri-operative factors associated with brainstem invasion encountered during surgery. Methods The study population included pediatric patients undergoing surgery for common posterior fossa tumors over period of 10 years. Rare diagnosis were omitted for sake of clarity in analysis. It was a retrospective audit of prospectively maintained database. Presence of brainstem involvement was noted from the operative notes. Presence of brainstem invasion was correlated with peri-operative factors for significant association. Results The study population included 202 patients of posterior fossa tumors operated at our institute. 62.9% were males and 37.1% were females. 50 % of patients had neurodeficits pre-operatively and 45% presented with raised ICP. Brainstem involvement was seen in 57.4 % of patients (varying degrees) intra-operatively. The common histology were embryonal (49.5%), astrocytic (30.2%) and ependymal (20.3%).Post-operative neurological worsening was seen in 22.8%. The presence of brainstem invasion was not associated with gender, pre-op neurological status, and tumor size. Brainstem invasion was most common in ependymal tumors (73.2%), followed by astrocytic (55.7%) and embryonal tumors (52%) (p=.06).It had statistically significant association with post-operative neurological status and morbidity, wound related complications, use of prolonged antibiotics and post-operative residual disease. Conclusion Presence of brainstem involvement predicts adverse post-operative course and presence of residual disease in pediatric posterior fossa patients undergoing surgery.