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Long-Term Neurological Outcome of Childhood Brain Tumors Treated by Surgery Only

Signe Sønderkær, Marianne Schmiegelow, Henrik Carstensen, Lars Bøgeskov Nielsen, Jørn Müller, Kjeld Schmiegelow

From the Pediatric Clinic II and the Department of Growth and Reproduction, Juliane Marie Center, Clinic of Neurosurgery, Neurocenter, The University Hospital, H:S Rigshospitalet, Copenhagen 2100, Denmark.

Address reprint requests to Kjeld Schmiegelow, PhD, Pediatric Clinic II, Juliane Marie Center, H:S Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark; email: kschmiegelow{at}rh.dk.

Purpose: To evaluate the pattern of neurological late effects in patients who have received surgery only for a brain tumor in childhood and to identify possible risk factors for neurological sequelae.

Patients and Methods: The medical, histologic, and operative records were reviewed for 65 consecutive patients operated for a benign brain tumor from 1970 to 1997, and all patients were re-examined after a median length of follow-up of 10.7 years. Thirty-four patients had posterior fossa tumors, 22 patients had cerebral hemisphere tumors, and nine patients had midline tumors.

Results: At the time of follow-up, 20 patients (31%) had no neurological deficits, 22 patients (34%) had minor deficits that did not interfere with their daily life activities, and 23 patients (35%) had moderate or severe deficits such as severe ataxia, spastic paresis, seriously reduced vision, or epilepsy with more than two seizures per year. Fourteen of the 31 patients (45%) registered with ataxia preoperatively had recovered fully. Six of seven patients had persistence of a pre- or postoperatively developed hemiparesis. Thirteen of 23 patients had persistence of cranial nerve deficits that developed second to surgery. Fifty-five percent of the 18 patients with seizures at diagnosis were seizure-free at follow-up. At follow-up both ataxia and hemiparesis were significantly more frequent among females (P = .02 and P = .03, respectively).

Conclusion: In patients who received operation as the only treatment for their brain tumor, there was a good chance of total or partial recovery of preoperative and postoperative neurological deficits, although only one third of the patients will have no long-term neurological deficits.

Supported by The Ville Heise Foundation (grant M1-96), The Haensch Foundation, and the Fraenkel Foundation.

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