Premio Junior: Astrocitoma pilocítico cerebeloso Estudio de cohorte retrospectivo evaluando el resultado funcional postoperatorio, el mutismo y la hidrocefalia.

Abstract

Objective: Analyze a series of pediatric patients with cPAs evaluating factors that may determine the final outcome in terms of neurological status, mutism and hydrocephalus.
Materials and methods: Single Center, retrospective study of a cohort of surgical patients with cPA and a minimum of 12 months follow-up. Clinical, imaging and surgical features, histopathology and adjuvancy were assessed. Patient´s clinical outcome was categorized using the FSS and Bloom-Scale at short and long term.
Results: A total of 100 patients with a mean follow-up of 53.9 months were included. 54% of the analyzed population was female and the mean age was 7.6  years. The most frequent location was central and 24% of tumors were associated with brainstem  invasion. Hydrocephalus was present in 79 patients at diagnosis requiring preoperative treatment in 48% of cases. GTR was achieved in 67% of patients. Mutism was observed in 15 patients and statistically associated with location, pontine-invasion, preoperative Bloom-score and postoperative meningitis/ventriculitis.
Functional outcome correlated to complications such as meningitis/ventriculitis and cerebellar hematoma,  mutism and recurrence.
Recurrence was seen in 26% of cases and reoperation was the therapeutic chosen followed by chemotherapy in almost half of patients.
Conclusion: The treatment of cPA in pediatric patients results in relatively favorable outcomes. Recurrence, mutism and surgical complications have shown significant prognostic value for outcome and should therefore be adequately managed. Early treatment with the intention of achieving GTR should be considered, accepting leaving residual tumor against neurologic harm on the contrary. Carefully tailored decisions should be taken when dealing with hydrocephalus at a prior instance.