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Published on: March 1, 2015
Predicting dysphagia in children undergoing surgery for posterior fossa tumors
Eric A Goethe1, Nisha Gadgil1, Katie Stormes1
1Department of Neurosurgery, Division of Pediatric Neurosurgery, Texas Children's Hospital, Baylor College of Medicine, 6701 Fannin St., Ste. 1230, Houston, TX, 77030, USA.
Insights
Posterior fossa tumor resection in children can cause dysphagia, particularly in younger patients with aggressive tumors. While most recover, some require long-term feeding support, highlighting the need for further research into persistent deficits.
Area of Science:
- Pediatric Neurosurgery
- Oncology
- Swallowing Disorders
Background:
- Posterior fossa tumors (PFTs) are the most common pediatric brain tumors.
- Dysphagia is a recognized complication following PFT resection in children, but risk factors and clinical outcomes are not well-defined.
Purpose of the Study:
- To investigate the risk factors and clinical course of dysphagia in children undergoing PFT resection.
- To identify predictors of persistent swallowing deficits and healthcare utilization.
Main Methods:
- Retrospective analysis of 197 children who underwent PFT resection between 2007 and 2017.
- Evaluation of clinical, radiographic, and histologic data.
- Assessment of swallowing function postoperatively and at 1-year follow-up.
Main Results:
- 21.8% of patients developed postoperative dysphagia.
- Younger age, brainstem compression/invasion, ependymoma, and atypical teratoid/rhabdoid tumors (ATRT) were associated with dysphagia.
- Dysphagia correlated with longer hospital stays and increased need for inpatient rehabilitation.
- 5.1% of patients remained PEG-dependent at 1-year follow-up, with ATRT being a significant factor.
Conclusions:
- Dysphagia post-PFT resection is linked to younger age, aggressive tumor histology, and higher healthcare resource utilization.
- Most children regain swallowing function, but a subset experiences persistent deficits requiring long-term enteral feeding.
- Further research is warranted to elucidate factors contributing to persistent dysphagia after PFT resection.
Purpose:
Posterior fossa tumors (PFTs) are the most common type of brain tumor in children. Dysphagia is a known complication of PFT resection in children, but data regarding risk factors and clinical course are sparse.
Methods:
The records of all children who underwent resection of posterior fossa tumor between April 2007 and May 2017 at our institution were analyzed. Clinical, radiographic, histologic data were gathered. Swallowing function was assessed immediately postoperatively and at 1-year follow-up.
Results:
A total of 197 patients were included. Forty-three (21.8%) patients developed dysphagia after surgery. Patients who developed dysphagia were younger (4.5 vs. 7.2 years, p < 0.01), were more likely to have brainstem compression (74.4% vs. 57.8%, p < 0.03) or invasion (14.0 vs. 9.7%, p < 0.03), and were more likely to have ependymoma (27.9% vs. 13.6%, p < 0.01) or ATRT (atypical teratoid/rhabdoid tumor) (9.3% vs. 3.9%, p < 0.01). Patients with postoperative dysphagia also had a longer length of stay (33.7 vs. 12.7 days, p < 0.01) and were more likely to be discharged to inpatient rehabilitation (25.6% vs. 9.1%, p < 0.01). Ten patients (5.1%) were PEG-dependent by 1-year follow-up. These patients were younger (2.7 vs. 5.6 years, p < 0.01), had a longer length of stay (55.5 vs. 27.4 days, p < 0.01), and were more likely to have ATRT (30.0% vs. 0.0%, p < 0.01). Recovery was not associated with tumor grade or extent of resection.
Conclusions:
Dysphagia after PFT resection is associated with younger age, aggressive tumor histology, and increased healthcare utilization. While most patients recover, a small percentage are still dependent on enteral feeding at 1-year follow-up. Further research is needed to identify factors associated with persistent deficits.
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