Pediatric brain stem lesions: introduction of a scoring system for clinical evaluation and their treatment analysis.
BACKGROUND
Brainstem lesions in pediatric age group include mainly gliomas. As these are not usually amenable to complete surgical resection, multimodality treatments are used. To assess treatment responses, Karnofsky's Performance Score (KPS) has been the gold standard; however, in pediatric patients, comprehensive neurological examination is more valuable.


OBJECTIVE
Our purpose was to formulate neurological examination based scoring system and compare its effectiveness with KPS.


METHODS
A retrospective analysis of 37 pediatric patients with brainstem lesions was performed. All these patients were assessed both pre- and post-treatment and in every follow up using standard KPS and our proposed scoring system, Kumar's and Samir's Score (K&SS). K&SS was devised choosing the common clinical features and those affecting outcome the most. Twenty-two features were hence selected, and points were allotted to each according to their functional importance, with range from 22 to 100.


CONCLUSIONS
Twenty-seven had gliomas, and in nonglioma group, seven had brainstem tuberculosis (BSTB). Nineteen patients with BSG were less than 6 years of age. Most gliomas were pilocytic astrocytomas (n = 21). Outcome analysis of patients in both groups using KPS showed deterioration or no change in the scores in majority whereas using K&SS, most patients showed improvement.


CONCLUSIONS
Gliomas form majority of pediatric brainstem lesions, with high occurrence of BSTB in nongliomatous group. Our proposed scoring system, based on comprehensive neurological examination, is more sensitive than KPS in treatment analysis of brainstem lesions.
Kumar
Raj
R
Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226014, Uttar Pradesh, India. rajkumar@sgpgi.ac.in
Kalra
Samir K
SK
D000367:Age Factors; D001930:Brain Injuries / Q000209:etiology / Q000473:pathology* / Q000628:therapy*; D001932:Brain Neoplasms / Q000150:complications; D001933:Brain Stem / Q000473:pathology*; D002648:Child; D002675:Child, Preschool; D003664:Decompression / Q000379:methods; D005260:Female; D005910:Glioma / Q000150:complications; D006801:Humans; D017567:Karnofsky Performance Status; D008297:Male; D009493:Neurosurgery / Q000379:methods*; D010043:Outcome and Process Assessment, Health Care; D010372:Pediatrics; D012189:Retrospective Studies