title: A comprehensive analysis of early outcomes and complication rates after 769 craniotomies in pediatric patients.
abstract: OBJECTIVE
  Perioperative complications following craniotomy in pediatric neurosurgery have received little attention. We analyzed perioperative complications and early outcomes following craniotomy in a large cohort of pediatric patients.
  
  
  METHODS
  A retrospective chart review identified 769 operations (27 % epilepsy surgery, 26 % trauma, 21 % tumor, 7 % vascular, 4 % infections, 14 % other, and 88 % supratentorial) in 641 patients <16 years (mean age 8.5 years). We recorded all perioperative complications and functional outcomes 30 days after surgery.
  
  
  RESULTS
  Excluding epilepsy surgery cases, 17.5 % patients had emergency surgery. There were 38 new major neurological deficits (5.0 %; excluding deficits incurred as part of the surgical strategy). New neurological deficits occurred more frequently following operations for brain tumors, when compared to other surgeries (P < 0.001), and after surgery for infratentorial lesions (P < 0.001). Local complications occurred in 3.9 %, systemic complications in 2.5 % of patients. Ventricular shunting or endoscopic ventriculostomy was necessary in 87 patients (11.3 %). Surgical mortality was 2.0 % (including moribund patients after trauma or vascular incidence). Preoperative Karnofsky Performance Index (KPI) and the incurrence of new neurological deficits proved the most powerful predictors of functional outcome. Emergency surgery or repeat craniotomies were not correlated with increased rates of local complications.
  
  
  CONCLUSIONS
  Craniotomies for pediatric patients carry a low morbidity and mortality. Systemic complications seem to occur less often in the pediatric than in the adult population. Good surgical outcomes require a proper balance between local pediatric neurosurgical care for emergency cases and centralized treatment of more difficult cases.
authors.affiliation: Department of Neurosurgery, University Hospital Bonn, Sigmund-Freud-Strasse 25, Bonn, Germany. Marec.von_Lehe@ukb.uni-bonn.de
authors.forename: M
authors.initials: M
authors.lastname: von Lehe
authors.forename: H-J
authors.initials: HJ
authors.lastname: Kim
authors.forename: J
authors.initials: J
authors.lastname: Schramm
authors.forename: M
authors.initials: M
authors.lastname: Simon
mesh_terms: D000293:Adolescent; D002648:Child; D003399:Craniotomy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D005260:Female; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000209:etiology*; D012189:Retrospective Studies; D016896:Treatment Outcome