Correlation of Neurosurgical Subspecialization with Outcomes in Children with Malignant Brain Tumors

Author:

Albright A. Leland1,Sposto Richard2,Holmes Emi2,Zeltzer Paul M.3,Finlay Jonathan L.4,Wisoff Jeffrey H.5,Berger Mitchel S.6,Packer Roger J.7,Pollack Ian F.1

Affiliation:

1. Department of Neurosurgery, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania

2. Department of Biostatistics, Children's Cancer Group, Arcadia, California

3. Department of Pediatrics (PMZ), Cedars-Sinai Los Angeles, Los Angeles, California

4. Departments of Hematology/Oncology, New York University, New York, New York

5. Neurosurgery, New York University, New York, New York

6. Department of Neurosurgery, University of California San Francisco, San Francisco, California

7. Department of Neurology, Children's National Medical Center, Washington, District of Columbia

Abstract

Abstract OBJECTIVE This study was performed to evaluate the association between the type of neurosurgeon (general or pediatric) and either the extent of tumor removal or the frequency of complications in children undergoing malignant brain tumor resections. METHODS Data were analyzed from three recent Children's Cancer Group studies: two on medulloblastomas/primitive neuroectodermal tumors and one on malignant gliomas. Neurosurgeons were classified as general neurosurgeons, as designated pediatric neurosurgeons in their institutions, or as members of the American Society of Pediatric Neurosurgeons (ASPN), which requires pediatric neurosurgical experience and practice standards. RESULTS Data forms from 732 children were analyzed; 485 were from children with medulloblastomas/primitive neuroectodermal tumors, and 247 were from children with malignant gliomas. Operations were performed by 269 neurosurgeons, including 213 general neurosurgeons, 29 designated pediatric neurosurgeons, and 27 ASPN members. The mean number of operations per surgeon was 1.8, 4.9, and 7.6 for general neurosurgeons, designated pediatric neurosurgeons, and ASPN members, respectively. There was a significant relationship between the extent of tumor resection or the amount of residual tumor and the type of neurosurgeon. Designated pediatric neurosurgeons and ASPN members were more likely to remove more than 90% of the tumor and to leave less than 1.5 cc of residual tumor than were general neurosurgeons (P < 0.05). In these studies, the probability of extensive tumor removal correlated with the number of operations the neurosurgeon performed (P < 0.01). Neurological complications occurred in the following proportion of cases: general neurosurgeons, 23%; designated pediatric neurosurgeons, 32%; and ASPN members, 18%. CONCLUSION Pediatric neurosurgeons are more likely than general neurosurgeons to extensively remove malignant pediatric brain tumors. In these tumors, extent of removal has been demonstrated to influence survival.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Clinical Neurology,Surgery

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