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Congenital Brain Tumors: Surgical Outcomes and Long-Term Prognostic Factors
Ahmet Ilkay Isikay1, Muhammet Enes Gurses1, Neslihan Nisa Gecici1
1Department of Neurosurgery, Faculty of Medicine, Hacettepe University, Ankara, Turkey.
Insights
Surgical resection is vital for infant congenital brain tumors (CBTs). However, high-grade malignant tumors present poor prognosis despite aggressive treatment, highlighting the need for improved therapeutic strategies.
Area of Science:
- Pediatric Neurosurgery
- Oncology
- Congenital Neuropathology
Background:
- Congenital brain tumors (CBTs) are rare and pose significant challenges in infant management.
- Long-term outcomes and prognostic factors for CBTs in infants are not well-defined.
Purpose of the Study:
- To assess the long-term results of surgical intervention for CBTs in infants under one year of age.
- To identify key factors influencing survival rates in this pediatric population.
Main Methods:
- Retrospective analysis of 70 infants undergoing gross total or subtotal resection for CBTs (2001-2019).
- Inclusion of demographic, clinical, and tumor characteristic data, including hydrocephalus and adjuvant therapies.
- Cox regression analysis to determine survival predictors.
Main Results:
- Overall 5- and 10-year survival rates were 78% and 63%, respectively.
- High-grade tumors, preoperative hydrocephalus, larger tumor size, and ventriculoperitoneal shunt placement were linked to reduced survival.
- Tumor grade and size independently predicted poor prognosis.
Conclusions:
- Surgical resection is essential for infant CBTs, but malignant tumors have poor long-term outcomes.
- Neurological sequelae are common in long-term survivors, emphasizing the need for comprehensive care.
Objective:
To evaluate long-term outcomes of surgical resection for congenital brain tumors (CBTs) in infants under one year of age and to identify factors related to survival.
Methods:
Our retrospective study analyzed infants who underwent gross total or subtotal resection (STR) for CBTs between 2001 and 2019. Data were obtained from medical records, including demographics, clinical presentation, diagnosis, tumor characteristics, and presence of hydrocephalus. Additional factors such as preoperative and/or postoperative ventriculoperitoneal shunt placement and adjuvant chemotherapy or radiotherapy were also reviewed. Cox regression analysis was used to identify factors associated with survival.
Results:
The study included 70 patients, with median age at surgery of 198.5 days, and 28 (40%) were girls. Seizures (31.4%) and vomiting (24.3%) were the most common presenting symptoms. High-grade tumors were present in 29 (41.4%) patients. Gross total resection was achieved in 64.3% of cases, with surgical mortality rate of 7.1%. Overall survival rates at 5 and 10 years were 78% and 63%, respectively. Long-term follow-up data were available for 61 patients (87%), with median follow-up of 74.2 months. Among 45 long-term survivors, 55.5% had neurological sequelae. Factors associated with reduced survival included high-grade, preoperative hydrocephalus, larger tumor size, and ventriculoperitoneal shunt placement. The extent of resection improved survival only in low-grade tumor cases. Multivariable Cox regression analysis identified tumor grade and size as independent predictors of poor prognosis.
Conclusions:
Surgical resection remains crucial for treating CBTs in infants under one year, yet the aggressive nature of malignant tumors results in suboptimal outcomes regarding prognosis.
