Midline Posterior Fossa Tumors in Young Adults: Evolution of Thought and Practice

  • Fauzia Sajjad Punjab Institute of Neurosciences, Lahore
  • Sundus Ali Mayo Hospital, Lahore
  • Muhammad Akmal Punjab Institute of Neurosciences, Lahore
  • Zain Saleh Punjab Institute of Neurosciences, Lahore
  • Adeeb ul Hassan Punjab Institute of Neurosciences, Lahore
  • Imran Ali Punjab Institute of Neurosciences, Lahore
  • Muhammad Ishfaq
  • Asad Shah Punjab Institute of Neurosciences, Lahore
  • Mohsin Ali Raza Punjab Institute of Neurosciences, Lahore
Keywords: Posterior fossa tumors, Medulloblastoma in pediatric population, Ependymoma

Abstract

Objective:  The aim of our study was to evaluate the surgical outcome of posterior fossa lesions and to find out the relation between surgical skill and post-operative outcome and to determine how evolution in surgical skill dictates post-operative outcome.

Material & Methods:  This was a retrospective analysis of 207 patients with midline posterior fossa lesions over a period of 10 years from Jan 2009 till December 2018. The degree of surgical outcome was assessed by degree of surgical resection, Post-operative neurological deficits and complications, Stay in ICU and duration in hospital.

Results:  207 Midline posterior fossa tumors were operated. Headache was leading symptom in patients followed by vomiting and balance problem. Medulloblastoma was a most common pathology in 133, Ependymoma 32, Astrocytoma in 28 Choroid Plexus Papilloma in 3, dermoid cyst 3,arachnoid cyst 4 and Hemangioblastoma in 4 patients. Gross Total resection was possible in 110 patients. Post operatively gag reflex was impaired in 36 and facial palsy in 5 patients. Chest infection was the most common complication in 84 patients, followed by wound infection, CSF Leak and Meningitis. Mortality was 11.59% as 24 patients died within one month, while 28.5% patients stayed in ICU.

Conclusion:  Post-operative mortality and morbidity is relatively high among post fossa tumors. Improvement in surgical skills better instruments revealed better outcome over a period of 10 years due to better understanding of microsurgical anatomy and utilization of modern therapeutic strategies for resection.

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Published
2020-10-01
Section
Original Article