Palliative procedures in the management of brain tumours in children. Change of therapeutic strategy over the last 25 years--an institutional experience Department of Neurosurgery of the Children's Memorial Health Institute in Warsaw.
OBJECTIVE
The growing incidence of paediatric brain tumours and improved treatment outcome result in longer survival time. In this context, the issue of palliative treatment is becoming increasingly important. THE AIM of this paper is to assess the role of palliative procedures in the treatment of paediatric brain tumours and to analyze changes in therapeutic strategy concerning palliative procedures that have taken place within the last 25 years in one institution.


METHODS
During the last 25 years (between 1980 and 2005), at the Department of Neurosurgery of the Children's Memorial Health Institute we have treated a total of 3279 children with the principal diagnosis of "CNS tumour", who underwent 611 palliative procedures. In 36 cases we performed a combined therapeutic-diagnostic procedure. This is a retrospective study, based on a review of medical records and search of our clinical database.


RESULTS
There were significant differences in the frequency of palliative procedures depending on particular tumour location. There was also a significant linear increase of both the numbers and proportion of palliative procedures in consecutive years. Morbidity associated with palliative procedures was 1.8% and there was 1 perioperative death.


CONCLUSIONS
1. There are significant differences in the frequency of palliative procedures performed in the treatment of paediatric brain tumours depending on their location. 2. There was a quantitative and proportional linear growth of frequency of palliative procedures performed over the last 25 years; a wider spectrum of available therapeutic options increased the scope of neurosurgical interventions. 3. Combination of stereotactic, endoscopic and neuronavigational techniques is of considerable benefit in the treatment of brain tumours in children.
Daszkiewicz
Paweł
P
Klinika Neurochirurgii, Instytut Pomnik - Centrum Zdrowia Dziecka, Warszawa. nch@czd.pl; pmdaszkiewicz@o2.pl
Barszcz
Sławomir
S
Walencik
Adam
A
D000047:Academies and Institutes; D000293:Adolescent; D001932:Brain Neoplasms / Q000453:epidemiology* / Q000601:surgery / Q000628:therapy*; D002648:Child; D002662:Child Health Services / Q000706:statistics & numerical data*; D002669:Child Welfare / Q000706:statistics & numerical data*; D002675:Child, Preschool; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008499:Medical Records / Q000706:statistics & numerical data; D019635:Neurosurgical Procedures / Q000706:statistics & numerical data; D010166:Palliative Care / Q000706:statistics & numerical data*; D011044:Poland / Q000453:epidemiology