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A decision analysis tool for the assessment of posterior fossa tumour surgery outcomes in children—the “Liverpool Neurosurgical Complication Causality Assessment Tool”

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Abstract

Introduction

Complications may occur following posterior fossa tumour surgery in children. Such complications are subjectively and inconsistently reported even though they may have significant long-term behavioural and cognitive consequences for the child. This makes comparison of surgeons, programmes and treatments problematic.

Materials and methods

We have devised a causality tool for assessing if an adverse event after surgery can be classified as a surgical complication using a series of simple questions, based on a tool used in assessing adverse drug reactions. This tool, which we have called the “Liverpool Neurosurgical Complication Causality Assessment Tool”, was developed by reviewing a series of ten posterior fossa tumour cases with a panel of neurosurgery, neurology, oncology and neuropsychology specialists working in a multidisciplinary paediatric tumour treatment programme.

Discussion and conclusion

We have demonstrated its use and hope that it may improve reliability between different assessors both in evaluating the outcomes of existing programmes and treatments as well as aiding in trials which may directly compare the effects of surgical and medical treatments.

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References

  1. Bruce J, Russell EM, Mollison J, Krukowski ZH (2001) The measurement and monitoring of surgical adverse events. Health Technol Assess 5(22):1–194

    PubMed  CAS  Google Scholar 

  2. Buzunov E, Ojemann JG, Robinson FR (2010) Rhesus macaque as an animal model for posterior fossa syndrome following tumor resection. Pediatr Neurosurg 46(2):120–126

    Article  PubMed  Google Scholar 

  3. Catsman-Berrevoets CE, Van Dongen HR, Mulder PG, Paz y Geuze D, Paquier PF, Lequin MH (1999) Tumour type and size are high risk factors for the syndrome of “cerebellar” mutism and subsequent dysarthria. J Neurol Neurosurg Psychiatry 67(6):755–757

    Article  PubMed  CAS  Google Scholar 

  4. Clavien PA, Sanabria JR, Strasberg SM (1992) Proposed classification of complications of surgery with examples of utility in cholecystectomy. Surgery 111(5):518–526

    PubMed  CAS  Google Scholar 

  5. Di Rocco C, Chieffo D, Pettorini BL, Massimi L, Caldarelli M, Tamburrini G (2010) Preoperative and postoperative neurological, neuropsychological and behavioral impairment in children with posterior cranial fossa astrocytomas and medulloblastomas: the role of the tumor and the impact of the surgical treatment. Childs Nerv Syst 26(9):1173–1188

    Article  PubMed  Google Scholar 

  6. Drachman DA, Diamond ER, Hart CW (1977) Posturally-evoked vomiting; Association with posterior fossa lesions. Ann Otol Rhinol Laryngol 86(1 Pt 1):97–101

    PubMed  CAS  Google Scholar 

  7. Dubey A, Sung W-S, Shaya M, Patwardhan R, Willis B, Smith D, Nanda A (2009) Complications of posterior cranial fossa surgery—an institutional experience of 500 patients. Surg Neurol 72(4):369–375

    Article  PubMed  Google Scholar 

  8. Gallagher RM, Kirkham JJ, Mason JR, Bird KA, Williamson PR, Nunn AJ, Pirmohamed M (2011) Development and inter-rater reliability of the Liverpool adverse drug reaction causality assessment tool. PLoS One 6(12):e28096

    Article  PubMed  CAS  Google Scholar 

  9. Kao GD, Goldwein JW, Schultz DJ, Radcliffe J, Sutton L, Lange B (1994) The impact of perioperative factors on subsequent intelligence quotient deficits in children treated for medulloblastoma/posterior fossa primitive neuroectodermal tumors. Cancer 74(3):965–971

    Article  PubMed  CAS  Google Scholar 

  10. Korah MP, Esiashvili N, Mazewski CM, Hudgins RJ, Tighiouart M, Janss AJ, Marcus RB (2010) Incidence, risks, and sequelae of posterior fossa syndrome in pediatric medulloblastoma. Int J Radiat Oncol Biol Phys 77(1):106–112

    Article  PubMed  Google Scholar 

  11. Mei C, Morgan AT (2011) Incidence of mutism, dysarthria and dysphagia associated with childhood posterior fossa tumour. Childs Nerv Syst 27(7):1129–1136

    Article  PubMed  Google Scholar 

  12. Mitropoulos D, Artibani W, Graefen M, Remzi M, Rouprêt M, Truss M (2012) Reporting and grading of complications after urologic surgical procedures: an ad hoc EAU guidelines panel assessment and recommendations. Eur Urol 61(2):341–349

    Article  PubMed  Google Scholar 

  13. Orgel E, Jain S, Ji L, Pollick L, Si S, Finlay J, Freyer DR (2012) Hearing loss among survivors of childhood brain tumors treated with an irradiation-sparing approach. Pediatr Blood Cancer 58(6):953–958

    Article  PubMed  Google Scholar 

  14. Ozgur BM, Berberian J, Aryan HE, Meltzer HS, Levy ML (2006) The pathophysiologic mechanism of cerebellar mutism. Surg Neurol 66(1):18–25

    Article  PubMed  Google Scholar 

  15. Pomposelli JJ, Gupta SK, Zacharoulis DC, Landa R, Miller A, Nanda R (1997) Surgical complication outcome (SCOUT) score: a new method to evaluate quality of care in vascular surgery. J Vasc Surg 25(6):1007–1014, discussion 1014–5

    Article  PubMed  CAS  Google Scholar 

  16. Puget S, Boddaert N, Viguier D, Kieffer V, Bulteau C, Garnett M, Grill J (2009) Injuries to inferior vermis and dentate nuclei predict poor neurological and neuropsychological outcome in children with malignant posterior fossa tumors. Cancer 115(6):1338–1347

    Article  PubMed  Google Scholar 

  17. Robertson PL, Muraszko KM, Holmes EJ, Sposto R, Packer RJ, Gajjar A, Allen JC (2006) Incidence and severity of postoperative cerebellar mutism syndrome in children with medulloblastoma: a prospective study by the Children’s Oncology Group. J Neurosurg 105(6 Suppl):444–451

    PubMed  Google Scholar 

  18. Roncadin C, Dennis M, Greenberg ML, Spiegler BJ (2008) Adverse medical events associated with childhood cerebellar astrocytomas and medulloblastomas: natural history and relation to very long-term neurobehavioral outcome. Childs Nerv Syst 24(9):995–1002, discussion 1003

    Article  PubMed  Google Scholar 

  19. Shanmugam G, Clark LL, Burton HJ, Warren AE, O’Blenes SB, Hancock Friesen CL (2012) Improving and standardizing capture of pediatric cardiac surgical complications. J Thorac Cardiovasc Surg 144(3):570–576

    Article  PubMed  Google Scholar 

  20. Sonderkaer S (2003) Long-term neurological outcome of childhood brain tumors treated by surgery only. J Clin Oncol 21(7):1347–1351

    Article  PubMed  Google Scholar 

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Correspondence to Rasheed Zakaria.

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Zakaria, R., Ellenbogen, J., Graham, C. et al. A decision analysis tool for the assessment of posterior fossa tumour surgery outcomes in children—the “Liverpool Neurosurgical Complication Causality Assessment Tool”. Childs Nerv Syst 29, 1277–1283 (2013). https://doi.org/10.1007/s00381-013-2065-0

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