title: Neurological morbidity of surgical resection of pediatric cerebellar astrocytomas.
abstract: BACKGROUND
  Review of children with low-grade cerebellar astrocytoma (LGCA) prior to 1992 showed a 98% rate of gross total resection (GTR) but a concerning incidence of permanent neurological dysfunction. The purpose of this study was to determine the rate of GTR of LGCA since 1992 and frequency of neurologic injury.
  
  
  METHODS
  Retrospective review of children with LGCA was performed. CT/MR scans were rereviewed to assess extent of resection. Primary outcomes included incidence of GTR and incidence of permanent new neurological deficits. Other outcomes included late effects severity score (LESS), Bloom score for functional status, and educational assessment.
  
  
  RESULTS
  Of 50 LGCA, GTR was achieved in 38 (76%) compared to 43 of 44 (98%) prior to 1992 (p < 0.004). Permanent new neurologic deficits from surgery occurred in 16% compared to 18% in the prior era (p = 0.61). For 35 patients operated on by the 2 surgeons in the prior study, 74% had GTR, with permanent neurological deficits in 8.6%. At latest follow-up, all patients were alive, 16% with residual tumor. LESS was two or less (mild or no deficit) in 94%. Bloom score was one or two (no or mild disability) in 90%. Eighty-six percent attended normal school.
  
  
  CONCLUSIONS
  Less aggressive resection of LGCA in children may reduce postoperative neurologic deficits in the hands of the same surgeons as in the prior study but not overall at our institution. The good long-term outcomes suggest that it may be appropriate to do incomplete resection rather than risk additional neurological deficit.
authors.affiliation: Division of Pediatric Neurosurgery, Department of Surgery, BC Children's Hospital and University of British Columbia, 4480 Oak St, #K3-159, V6H 3V4, Vancouver, BC, Canada. psteinbok@cw.bc.ca
authors.forename: Paul
authors.initials: P
authors.lastname: Steinbok
authors.forename: Jaspreet Singh
authors.initials: JS
authors.lastname: Mangat
authors.forename: John M
authors.initials: JM
authors.lastname: Kerr
authors.forename: Michael
authors.initials: M
authors.lastname: Sargent
authors.forename: Wihasto
authors.initials: W
authors.lastname: Suryaningtyas
authors.forename: Ashutosh
authors.initials: A
authors.lastname: Singhal
authors.forename: Doug
authors.initials: D
authors.lastname: Cochrane
mesh_terms: D000293:Adolescent; D001254:Astrocytoma / Q000150:complications / Q000401:mortality* / Q000601:surgery*; D002528:Cerebellar Neoplasms / Q000150:complications / Q000401:mortality* / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007223:Infant; D053208:Kaplan-Meier Estimate; D008279:Magnetic Resonance Imaging; D008297:Male; D009422:Nervous System Diseases / Q000175:diagnosis / Q000209:etiology; D019635:Neurosurgical Procedures / Q000379:methods*; D011183:Postoperative Complications / Q000503:physiopathology; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome