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Predicting dysphagia in children undergoing surgery for posterior fossa tumors

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Abstract

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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Abbreviations

PFT:

posterior fossa tumor

ATRT:

atypical teratoid/rhabdoid tumor

PEG:

percutaneous endoscopic gastrostomy

VFSS:

videofluoroscopic swallow study

JPA:

juvenile pilocytic astrocytoma

GTR:

gross total resection

STR:

subtotal resection

References

  1. Cornwell PL, Murdoch BE, Ward EC, Morgan A (2003) Dysarthria and dysphagia as long-term sequelae in a child treated for posterior fossa tumour. Pediatr Rehabil 6:67–75. https://doi.org/10.1080/1363849031000139289

    Article  PubMed  Google Scholar 

  2. Gustafsson B, Tibbling L (1991) Dysphagia, an unrecognized handicap. Dysphagia. 6:193–199

    Article  CAS  Google Scholar 

  3. Hudgins RJ, Edwards MS (1987) Management of infratentorial brain tumors. Pediatr Neurosci 13:214–222

    Article  CAS  Google Scholar 

  4. Kurien M, Andrews RE, Tattersall R, McAlindon ME, Wong EF, Johnston AJ, Hoeroldt B et al (2017) Gastrostomies preserve but do not increase quality of life for patients and caregivers. Clin Gastroenterol Hepatol 15:1047–1054. https://doi.org/10.1016/j.cgh.2016.10.032

    Article  PubMed  Google Scholar 

  5. Lee WH, Oh B-M, Seo HG, Kim SK, Phi JH, Chong S, Han TR (2016) One-year outcome of postoperative swallowing impairment in pediatric patients with posterior fossa brain tumor. J Neuro-Oncol 127:73–81. https://doi.org/10.1007/s11060-015-2010-z

    Article  Google Scholar 

  6. Mei C, Morgan AT (2011) Incidence of mutism, dysarthria and dysphagia associated with childhood posterior fossa tumour. Childs Nerv Syst 27:1129–1136. https://doi.org/10.1007/s00381-011-1433-x

    Article  PubMed  Google Scholar 

  7. Morgan AT, Sell D, Ryan M, Raynsford E, Hayward R (2008) Pre and post-surgical dysphagia outcome associated with posterior fossa tumour in children. J Neuro-Oncol 87:347–354. https://doi.org/10.1007/s11060-008-9524-6

    Article  Google Scholar 

  8. Morgan AT, Dodrill P, Ward EC (2012) Interventions for oropharyngeal dysphagia in children with neurological impairment. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD009456.pub2

  9. Newman LA, Boop FA, Sanford RA, Thompson JW, Temple CK, Duntsch CD (2006) Postoperative swallowing function after posterior fossa tumor resection in pediatric patients. Childs Nerv Syst 22:1296–1300. https://doi.org/10.1007/s00381-006-0065-z

    Article  PubMed  Google Scholar 

  10. Rahnemai-Azar AA, Rahnemaiazar AA, Naghshizadian R, Kurtz A, Farkas DT (2014) Percutaneous endoscopic gastrostomy: indications, technique, complications and management. World J Gastroenterol 20:7739–7751. https://doi.org/10.3748/wjg.v20.i24.7739

    Article  PubMed  PubMed Central  Google Scholar 

  11. Ram Z, Grossman R (2014) Dysphagia as a complication of posterior Fossa surgery in adults. World Neurosurg 82:625–626. https://doi.org/10.1016/j.wneu.2013.02.045

    Article  PubMed  Google Scholar 

  12. Rommel N, Hamdy S (2016) Oropharyngeal dysphagia: manifestations and diagnosis. Nat Rev Gastroenterol Hepatol 13:49–59. https://doi.org/10.1038/nrgastro.2015.199

    Article  PubMed  Google Scholar 

  13. Shem KL, Castillo K, Wong SL, Chang J, Kao M-C, Kolakowsky-Hayner SA (2012) Diagnostic accuracy of bedside swallow evaluation versus videofluoroscopy to assess dysphagia in individuals with tetraplegia. PM R 4:283–289. https://doi.org/10.1016/j.pmrj.2012.01.002

    Article  PubMed  Google Scholar 

  14. Snider CA, Yang K, Mack SC, Suh JH, Chao ST, Merchant TE, Murphy ES (2018) Impact of radiation therapy and extent of resection for ependymoma in young children: a population-based study. Pediatr Blood Cancer 65:e26880. https://doi.org/10.1002/pbc.26880

    Article  Google Scholar 

  15. Spennato P, Nicosia G, Quaglietta L, Donofrio V, Mirone G, Di Martino G et al (2015) Posterior fossa tumors in infants and neonates. Childs Nerv Syst 31:1751–1772. https://doi.org/10.1007/s00381-015-2783-6

    Article  PubMed  Google Scholar 

  16. Steinbok P, Mangat JS, Kerr JM, Sargent M, Surianingtyas W, Singhal A, Cochrane D (2013) Neurological morbidity of surgical resection of pediatric cerebellar astrocytomas. Childs Nerv Syst 29:1269–1275. https://doi.org/10.1007/s00381-013-2171-z

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Neurosurgery, Division of Pediatric Neurosurgery, Texas Children’s Hospital, Baylor College of Medicine, 6701 Fannin St., Ste. 1230, Houston, TX, 77030, USA

    Eric A. Goethe, Nisha Gadgil, Katie Stormes, Audrey Wassef & Melissa LoPresti

  2. Division of Pediatric Neurosurgery, Ann and Robert H Lurie Children’s Hospital, Chicago, IL, 60611, USA

    Sandi Lam

  3. Department of Neurosurgery, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA

    Sandi Lam

Authors
  1. Eric A. Goethe
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  2. Nisha Gadgil
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  3. Katie Stormes
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  4. Audrey Wassef
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Correspondence to Sandi Lam.

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IRB approval was obtained for this project.

Portions of this work were presented in poster form at the 2019 AANS Annual Scientific Meeting in San Diego, CA.

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The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

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Goethe, E.A., Gadgil, N., Stormes, K. et al. Predicting dysphagia in children undergoing surgery for posterior fossa tumors. Childs Nerv Syst 36, 925–931 (2020). https://doi.org/10.1007/s00381-019-04468-7

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  • DOI: https://doi.org/10.1007/s00381-019-04468-7

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