Morbidity of second-look surgery in pediatric central nervous system tumors

The extent of brain tumor resection affects survival. Second-look surgery (resection of residual tumor before radiographic progression) may improve survival by reducing the tumor burden, but the morbidity of the procedure is not known. On chart review of 280 patients with two or more brain tumor operations treated between January 1985 and June 1998, we identified 47 patients with second-look surgery. Lansky and Eastern Cooperative Oncology Group (ECOG) performance scores, as well as perioperative complications were recorded. There were 21 gliomas (6 malignant), 12 medulloblastomas, 3 craniopharyngiomas, 3 ependymomas and 8 miscellaneous tumors. Median time to second surgery was 50 days. Perioperative complications occurred in 45% of patients. There was no significant change in the mean Lansky and ECOG scores 4 and 24 weeks after surgery. Gross total resection (GTR) was achieved in 62% of patients and near total resection (NTR) in 23%, and 15% of patients had subtotal resection. GTR or NTR was achieved in 66% of medulloblastomas and 100% of gliomas. We conclude that second-look surgery by experienced pediatric neurosurgeons has an acceptable morbidity and should be considered in patients with residual tumors.