Abstract Background The treatment of pediatric brain tumors presents unique challenges due to the diversity of histology, tumor location in the developing brain, and the critical importance of preserving long-term neurological and cognitive function. This study analyzes the surgical experience, strategies, and outcomes based on a large cohort from the Federal Neurosurgical Center Novosibirsk, Russia. Methods A retrospective review of 613 consecutive pediatric patients (aged 0-18 years) treated surgically between 2013 and 2025 was performed. Tumors were classified by histology and location (supratentorial vs. infratentorial). Patients were stratified into age groups: 0-1 year (n = 57, 9.3%), 1-5 years (n = 102, 16.7%), 6-10 years (n = 160, 26%), 11-15 years (n = 173, 28.3%), and 16-18 years (n = 121, 19.7%). All surgeries utilized microsurgical techniques, with adjuncts including neuromonitoring (34%) and neuronavigation (92%). The extent of resection and outcomes were systematically evaluated. Results The most common histologies were LGG-pilocytic astrocytoma (30%), medulloblastoma (15%), ependymoma (10%), HGG (10%), craniopharyngioma (8%), and NonGCT (6%). Tumor distribution was 54% infratentorial and 46% supratentorial. Gross-total resection (GTR) was achieved in 78% of cases, with rates being higher for supratentorial (91%) than infratentorial (84%) lesions. GTR rates varied by age: 66% (0-1 yr), 72% (1-5 yrs), 81% (6-10 yrs), 80% (11-15 yrs), and 91% (16-18 yrs). The overall permanent major neurological morbidity rate was 4.1%, highest in the 0-1 year group (7.4%). The 3-year overall survival for the cohort was 78.5%, differing significantly by histology and resection completeness. Conclusion Our experience demonstrates that maximal safe resection is achievable across in the majority pediatric age groups, with success rates improving with patient age. The predominance of infratentorial tumors underscores the need for expertise in posterior fossa surgery. Younger age, particularly infancy, is associated with greater surgical challenge and higher morbidity, necessitating tailored perioperative management. Integrated, histology-specific multidisciplinary care remains paramount for optimizing long-term oncological and functional outcomes in children with brain tumors.
Danilin et al. (Tue,) studied this question.