Tumour volume as a predictor of postoperative speech impairment in children undergoing resection of posterior fossa tumours: a prospective, multicentre study
Aske Foldbjerg Laustsen, Shivaram Avula, Jonathan Grønbæk, Barry Pizer, Per Nyman, Pelle Nilsson, Radek Frič, Magnus Aasved Hjort, Vladimír Beneš, Peter Hauser, Beatrix Pálmafy, Giedre Rutkauskiene, Florian Wilhelmy, Rick Brandsma, Astrid Sehested, René Mathiasen, Marianne Juhler
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引用次数: 0
Abstract
Background
Cerebellar Mutism Syndrome (CMS) is a neurological complication of posterior fossa (PF) tumour surgery in children, and postoperative speech impairment (POSI) is the cardinal symptom of CMS. The role of tumour volume on the risk of POSI remains unexplored. This study investigates the association between tumour volume and the risk of POSI.
Methods
We included 360 patients from the European CMS study with available preoperative T1-weighted contrast-enhanced brain MRI. Speech status was assessed within two weeks postoperatively and categorised into three levels: habitual speech, severely reduced speech, and mutism. Tumour volumes were calculated using the BrainLab Elements SmartBrush™, a semi-automated segmentation tool. We used proportional odds models to estimate the odds ratio (OR) with adjustments for tumour location, pathology, and age. Based on the primary analysis, a risk stratification model for medulloblastoma patients was constructed, and the optimal volume cut-off was determined with Youden’s Index.
Results
We found no effect of the overall tumour volume on the risk of POSI. This result did not change when adjusted for tumour location, pathology, and age. We found an association between tumour volume of medulloblastoma and the risk of POSI (unadjusted OR of 1.04 per increase in cm3 (95% CI 1.01;1.07, p = 0.01)), which did not change when adjusting for tumour location and age. The risk stratification cut-off for the tumour volume of medulloblastoma was calculated to be 16,5 cm3. Patients with medulloblastoma and preoperative tumour volumes below 16,5 cm3 had an absolute risk of 13% for POSI (low-risk group), whereas patients with preoperative tumour volumes above 16,5 cm3 had an absolute risk of 50% for POSI (high-risk group).
Conclusion
Our data showed an association between preoperative tumour volume and the risk of POSI in children with medulloblastoma, while no association was found for the volume of other tumour types. We suggest a straightforward cut-off risk model for assessing the risk of POSI in children with medulloblastoma based on preoperative tumour volume. This approach can aid clinicians in informing patients and parents about the complications related to CMS following PF tumour surgery in children.
背景：小脑性失语综合征（CMS）是儿童后颅窝（PF）肿瘤手术后的一种神经系统并发症，而术后语言障碍（POSI）是CMS的主要症状。肿瘤体积对POSI风险的作用仍未研究。本研究探讨肿瘤体积与POSI风险之间的关系。方法我们纳入了360例来自欧洲CMS研究的患者，术前可用的t1加权对比增强脑MRI。术后两周内对患儿的语言状态进行评估，并将其分为习惯性语言、严重语言障碍和缄默症三个级别。使用BrainLab Elements SmartBrush™（一种半自动分割工具）计算肿瘤体积。我们使用比例优势模型来估计校正肿瘤位置、病理和年龄的优势比（OR）。在初步分析的基础上，构建成神经管细胞瘤患者的风险分层模型，并利用约登指数确定最佳容量临界值。结果肿瘤体积对POSI风险无影响。当调整肿瘤位置、病理和年龄时，这一结果没有改变。我们发现成神经管细胞瘤的肿瘤体积与POSI的风险之间存在关联（未经调整的OR为1.04 / cm3增加（95% CI 1.01;1.07, p = 0.01）），当调整肿瘤位置和年龄时，这种关联没有改变。髓母细胞瘤肿瘤体积的风险分层截止值计算为16.5 cm3。髓母细胞瘤患者术前肿瘤体积小于16.5 cm3的POSI绝对风险为13%（低风险组），而术前肿瘤体积大于16.5 cm3的患者POSI绝对风险为50%（高风险组）。结论：我们的数据显示成神经管细胞瘤患儿术前肿瘤体积与POSI风险存在相关性，而其他肿瘤类型的体积与POSI风险无相关性。我们建议一个基于术前肿瘤体积的直接切断风险模型来评估髓母细胞瘤儿童POSI的风险。这种方法可以帮助临床医生告知患者和家长有关儿童PF肿瘤手术后CMS的并发症。临床试验编号NCT02300766（2014年10月）。
期刊介绍：
The journal "Acta Neurochirurgica" publishes only original papers useful both to research and clinical work. Papers should deal with clinical neurosurgery - diagnosis and diagnostic techniques, operative surgery and results, postoperative treatment - or with research work in neuroscience if the underlying questions or the results are of neurosurgical interest. Reports on congresses are given in brief accounts. As official organ of the European Association of Neurosurgical Societies the journal publishes all announcements of the E.A.N.S. and reports on the activities of its member societies. Only contributions written in English will be accepted.
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