title: Does size matter? Minimally invasive approach in pediatric neurosurgery--a review of 125 minimally invasive surgeries in children: clinical history and operative results.
abstract: OBJECTIVE
  Surgery is an integral component and typically the first line of therapy for children with central nervous system tumors. Conventional aims of neurosurgery including tumor removal, management of hydrocephalus, and diagnostic sampling have been radically modified with innovative technologies such as navigational guidance, functional mapping, endoscopic surgery, second-look surgery, and physiologic imaging. The aim of the study was to investigate our operative results using minimally invasive technique in children.
  
  
  METHODS
  Clinical features, surgical technique and results, length of hospital stay, and complications were reviewed retrospectively. Pre- and early postoperative MRI was evaluated for degree of surgical resection. Correlation of tumor localization, lengths of hospital stay as well as surgical techniques and clinical outcome with follow-up was investigated.
  
  
  RESULTS
  One hundred ten patients underwent 125 tumor resections using minimally invasive approaches (image- and functional guided tailored keyhole approaches for supratentorial, retrosigmoidal, and suboccipital keyhole approaches for infratentorial lesions). Most tumors were located supratentorial (62.4 %). In 29.6 % of the cases, the surgery was performed endoscope-assisted or endoscope-controlled; neuronavigation was used in 45.6 % and ultrasound in 24 % of the cases. Astrocytomas were diagnosed in 26.4 % of cases, ependymomas in 9.6 %, and medulloblastomas in 14.4 %. Gross total resection was achieved in 60.8 %. The most common complication was CSF fistula (n = 9), and the occurrence was significantly higher in younger children (p = 0.0001) and infratentorial located tumors (p = 0.02). Surgery for posterior fossa lesions was associated with a longer hospital stay (p = 0.02) compared to surgery of supratentorial lesions. Mean follow-up was 29.7 months (range 0.3-79.1 months), and most of the children recovered during the further course of the follow-up (symptoms better or idem in 74.4 %).
  
  
  CONCLUSIONS
  In conclusion, our study shows that it is possible to achieve surgical results in the pediatric population applying minimal invasive techniques comparable to those described in the literature.
authors: Department of Neurosurgery, University Medical Center, Johannes-Gutenberg-University Mayence, Langenbeckstrasse 1, 55131, Mayence, Germany, mirjam.renovanz@unimedizin-mainz.de.
authors: M
authors: M
authors: Renovanz
authors: A K
authors: AK
authors: Hickmann
authors: A
authors: A
authors: Gutenberg
authors: M
authors: M
authors: Bittl
authors: N J
authors: NJ
authors: Hopf
mesh_terms: D000293:Adolescent; D001932:Brain Neoplasms / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D044583:Neuroendoscopy / Q000009:adverse effects / Q000379:methods; D038361:Neuronavigation / Q000009:adverse effects / Q000379:methods; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome