Cranial Neuropathies Associated With Pediatric Brain Tumors: Evaluation of Pediatric Otolaryngology Referral Patterns...

Background and aim Otolaryngologists play a crucial role in managing cranial nerve (CN) deficits in pediatric brain tumors. This study aims to determine rates of persistent cranial neuropathy and associated otolaryngology referral. Methods A total of 109 pediatric patients with primary intracranial neoplasms and documented CN deficits were retrospectively identified. Outcomes of interest included CN deficit, otolaryngology referral, recovery status, and surgical interventions. Variables were analyzed using chi-square and Fisher's exact tests. Results Cranial neuropathies persisted in 69 (63.3%) patients, the majority with posterior fossa tumors. Common deficits included facial weakness (N = 62, 56.9%), ophthalmoplegia (N = 59, 54.1%), vocal fold paresis (N = 11, 10.1%), dysphagia (N = 11, 10.1%), hearing loss (N = 9, 8.3%), and trigeminal neuropathy (N = 7, 6.4%). Twenty-two (20.2%) patients were referred to otolaryngology. Referred patients were significantly less likely to have achieved full recovery (X² = 5.53, p = 0.02) and more likely to undergo corrective intervention (X² = 15.88, p < 0.01). Vocal fold paresis, dysphagia, and hearing loss were each associated with referral (p < 0.01), whereas facial neuropathy, ophthalmoplegia, and trigeminal neuropathy were not. Notably, 51 of 87 (58.6%) non-referred patients demonstrated no recovery of their cranial neuropathy. Conclusions Despite high rates of persistent cranial neuropathies among pediatric patients with intracranial neoplasms, otolaryngology referrals remain notably infrequent, particularly for facial paralysis. Earlier and more systematic referrals may represent a meaningful opportunity to improve functional outcomes through earlier and timely intervention.