The Outcome of Surgical Excision of Giant Supratentorial Brain Tumors in Pediatrics: A Study of Consecutive 70 Cases at our Institute

Abstract Background: Surgery of giant supratentorial pediatric brain tumors (GSPBT) is challenging. Diagnosis may be misled by the inconspicuous symptoms and signs. Surgery is difficult due to the propensity for severe hemorrhage which is risky in this age group. Aim of Study: We discuss the surgical management of GSPBT with emphasis on how to reach maximal safe resection and different surgical strategies to improve the outcome. Patients and Methods: All Patients with GSPBT under-going elective surgery were included of age 3 months to 12 years. Giant tumors were defined by being larger than 5cm. General anesthesia was performed by neuroanesthesiologists. Various tools and instruments were used such as Cavitating ultrasonic aspirator, microscope and endoscope. Blood trans-fusion was performed as early as possible to replace losses. Extent of removal was assessed from CT or MRI scans. Results: This study included 70 children operated for GSPBT. There were 47 males (67.1%) and 23 females (32.9%). The age ranged from 3 to 144 months with a mean age of 56.3 months. The commonest presenting symptoms were those of raised intracranial pressure (ICP) in 61 cases (87.1%). Gross total resection was achieved in 57 patients (81.4%), debulking up to 80% in 3 patients (4.3%), debulking up to 50% in 1 patient (1.3%) and partial resection less than 50% in 9 patients (12.9%). The amount of blood transfusion ranged from 5 to 300ml/kg with a mean amount of 39.4ml/kg. PNET was the most common pathological diagnosis. Two cases required interruption of the procedure due to massive bleeding causing hypotension (2.9%). There were no complications due to massive blood transfusion. There were no cases of mortality. Conclusion: GSPBT can be totally resected with a good outcome. This needs a team approach including a good an-esthesia team and proper postoperative care. Surgical tech-niques including sub-pial technique, endo scope- assisted microsurgery, and the CUSA may help accomplish this target.