Neurosurgical morbidity in pediatric supratentorial midline low-grade glioma: Results from the German LGG studies.

person Michèle Simon Department of Pediatric Oncology and Hematology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany info_outline Michèle Simon, Sarah Weiß, Ulrich-Wilhelm Thomale, Matthias Schulz, Daniela Kandels, Martin Schuhmann, Ahmed ElDamaty, Juergen Krauss, Pablo Hernáiz Driever, Olaf Witt, Brigitte Bison, Torsten Pietsch, Gnekow Astrid

Authors person Michèle Simon Department of Pediatric Oncology and Hematology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany info_outline Michèle Simon, Sarah Weiß, Ulrich-Wilhelm Thomale, Matthias Schulz, Daniela Kandels, Martin Schuhmann, Ahmed ElDamaty, Juergen Krauss, Pablo Hernáiz Driever, Olaf Witt, Brigitte Bison, Torsten Pietsch, Gnekow Astrid Organizations Department of Pediatric Oncology and Hematology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany, Department of Pediatric Neurosurgery, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany, Swabian Children’s Cancer Center, Faculty of Medicine, University Augsburg, Augsburg, Germany, Division of Pediatric Neurosurgery, Department of Neurosurgery, University Hospital of Tuebingen, Eberhard Karls University of Tuebingen, Tuebingen, Germany, Division of Pediatric Neurosurgery, Department of Neurosurgery, Universitätsklinikum Heidelberg, Heidelberg, Germany, Department of Pediatric Neurosurgery, University Children's Hospital, University of Wuerzburg, Wuerzburg, Germany, German HIT-LOGGIC-Registry for LGG in children and adolescents, Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany, Hopp Children’s Cancer Center (KiTZ), University Hospital of Heidelberg and German Cancer Research Center, Heidelberg, Germany, Diagnostic and Interventional Neuroradiology, Faculty of Medicine, University of Augsburg, Augsburg, Germany, Department of Neuropathology and DGNN Brain Tumor Reference Center, University of Bonn Medical Center, Bonn, Germany Abstract Disclosures Research Funding No funding received None. Background: Surgical resection is a mainstay of treatment for pediatric low-grade glioma (LGG) within all current therapy algorithms, yet associated morbidity is scarcely reported. As supratentorial midline (SML) interventions are particularly challenging, we investigated the frequency of neurosurgical complications/new impairments aiming to identify their risk factors. Methods: Records were retrospectively analyzed from 318 patients with SML-LGG from successive German multicenter LGG studies, undergoing surgery between May 1998 and June 2020. Results: 537 operations (230 resections, 167 biopsies, 140 non-tumor procedures) were performed in 318 patients (54% male, median age: 7.6 years at diagnosis, 9.5 years at operation, 11% NF1, 42.5% optic pathway glioma). Surgical mortality rate was 0.93%. Applying the Drake classification, postoperative surgical morbidity was observed in 254/537 (47.3%) and medical morbidity in 97/537 (18.1%) patients with a 40.1% 30-day persistence rate for newly developed neurological deficits (65/162). Neuroendocrine impairment affected 53/318 patients (16.7%), visual deterioration 34/318 (10.7%). Postsurgical morbidity was associated with patient age <3 years at operation, tumor volume ≥80cm 3 , presence of hydrocephalus, complete resection, surgery in centers with less than median reported tumor-related procedures and during the earlier study period between 1998-2006, while the neurosurgical approach, tumor location, NF1 status or previous non-surgical treatment were not. Conclusions: Neurosurgery-associated morbidity was frequent in pediatric patients with SML-LGG undergoing surgery in the German LGG-studies. We identified patient- and institution-associated factors that may increase the risk for complications. We advocate that local multidisciplinary teams consider the planned extent of resection and surgical skills. Postsurgical morbidity according to the classification by Drake et al. * (n=537 interventions). All Surgical morbidity Medical morbidity Resections 260 324 incidences (170 patients) 85 incidences (69 patients) Biopsies 167 76 incidences (57 patients) 19 incidences (15 patients) Other interventions 140 36 incidences (27 patients) 13 incidences (13 patients) *Drake JM et al. Prospective surveillance of complications in a pediatric neurosurgery unit. J Neurosurg Pediatr. 2010.