Child's Nervous System

, Volume 29, Issue 5, pp 781–790 | Cite as

A comprehensive analysis of early outcomes and complication rates after 769 craniotomies in pediatric patients

  • M. von LeheEmail author
  • H.-J. Kim
  • J. Schramm
  • M. Simon
Original Paper



Perioperative complications following craniotomy in pediatric neurosurgery have received little attention. We analyzed perioperative complications and early outcomes following craniotomy in a large cohort of pediatric patients.


A retrospective chart review identified 769 operations (27 % epilepsy surgery, 26 % trauma, 21 % tumor, 7 % vascular, 4 % infections, 14 % other, and 88 % supratentorial) in 641 patients <16 years (mean age 8.5 years). We recorded all perioperative complications and functional outcomes 30 days after surgery.


Excluding epilepsy surgery cases, 17.5 % patients had emergency surgery. There were 38 new major neurological deficits (5.0 %; excluding deficits incurred as part of the surgical strategy). New neurological deficits occurred more frequently following operations for brain tumors, when compared to other surgeries (P < 0.001), and after surgery for infratentorial lesions (P < 0.001). Local complications occurred in 3.9 %, systemic complications in 2.5 % of patients. Ventricular shunting or endoscopic ventriculostomy was necessary in 87 patients (11.3 %). Surgical mortality was 2.0 % (including moribund patients after trauma or vascular incidence). Preoperative Karnofsky Performance Index (KPI) and the incurrence of new neurological deficits proved the most powerful predictors of functional outcome. Emergency surgery or repeat craniotomies were not correlated with increased rates of local complications.


Craniotomies for pediatric patients carry a low morbidity and mortality. Systemic complications seem to occur less often in the pediatric than in the adult population. Good surgical outcomes require a proper balance between local pediatric neurosurgical care for emergency cases and centralized treatment of more difficult cases.


Complications Craniotomy Neurosurgery Pediatric Outcome 


  1. 1.
    Albright AL, Pollack IF, Adelson PD, Solot JJ (1999) Outcome data and analysis in pediatric neurosurgery. Neurosurgery 45(1):101–106PubMedCrossRefGoogle Scholar
  2. 2.
    Allibone JB, Harkness WJ, Hayward RD (1999) Craniotomy-related complications in a paediatric neurosurgery unit—a prospective study. Br J Neurosurg 13(2):148–153PubMedCrossRefGoogle Scholar
  3. 3.
    Barker FG 2nd, Curry WT Jr, Carter BS (2005) Surgery for primary supratentorial brain tumors in the United States, 1988 to 2000: the effect of provider caseload and centralization of care. Neuro Oncol 7(1):49–63PubMedCrossRefGoogle Scholar
  4. 4.
    Behrens E, Schramm J, Zentner J, Konig R (1997) Surgical and neurological complications in a series of 708 epilepsy surgery procedures. Neurosurgery 41(1):1–9, discussion 9–10PubMedCrossRefGoogle Scholar
  5. 5.
    Brell M, Ibanez J, Caral L, Ferrer E (2000) Factors influencing surgical complications of intra-axial brain tumours. Acta Neurochir (Wien) 142(7):739–750CrossRefGoogle Scholar
  6. 6.
    Chang SM, Parney IF, McDermott M, Barker FG 2nd, Schmidt MH, Huang W, Laws ER Jr, Lillehei KO, Bernstein M, Brem H, Sloan AE, Berger M (2003) Perioperative complications and neurological outcomes of first and second craniotomies among patients enrolled in the Glioma Outcome Project. J Neurosurg 98(6):1175–1181PubMedCrossRefGoogle Scholar
  7. 7.
    Clusmann H, Kral T, Marin G, Van Roost D, Swamy K, Schramm J (2004) Characterization of hemorrhagic complications after surgery for temporal lobe epilepsy. Zentralbl Neurochir 65(3):128–134PubMedCrossRefGoogle Scholar
  8. 8.
    Cowan JA Jr, Dimick JB, Leveque JC, Thompson BG, Upchurch GR Jr, Hoff JT (2003) The impact of provider volume on mortality after intracranial tumor resection. Neurosurgery 52(1):48–53, discussion 53–44PubMedGoogle Scholar
  9. 9.
    Curry WT, McDermott MW, Carter BS, Barker FG 2nd (2005) Craniotomy for meningioma in the United States between 1988 and 2000: decreasing rate of mortality and the effect of provider caseload. J Neurosurg 102(6):977–986PubMedCrossRefGoogle Scholar
  10. 10.
    Dashti SR, Baharvahdat H, Spetzler RF, Sauvageau E, Chang SW, Stiefel MF, Park MS, Bambakidis NC (2008) Operative intracranial infection following craniotomy. Neurosurg Focus 24(6):E10PubMedCrossRefGoogle Scholar
  11. 11.
    Hassaneen W, Levine NB, Suki D, Salaskar AL, de Moura LA, McCutcheon IE, Prabhu SS, Lang FF, DeMonte F, Rao G, Weinberg JS, Wildrick DM, Aldape KD, Sawaya R (2011) Multiple craniotomies in the management of multifocal and multicentric glioblastoma. Clinical article J Neurosurg 114(3):576–584CrossRefGoogle Scholar
  12. 12.
    Kalfas IH, Little JR (1988) Postoperative hemorrhage: a survey of 4992 intracranial procedures. Neurosurgery 23(3):343–347PubMedCrossRefGoogle Scholar
  13. 13.
    Korinek AM, Golmard JL, Elcheick A, Bismuth R, van Effenterre R, Coriat P, Puybasset L (2005) Risk factors for neurosurgical site infections after craniotomy: a critical reappraisal of antibiotic prophylaxis on 4,578 patients. Br J Neurosurg 19(2):155–162PubMedCrossRefGoogle Scholar
  14. 14.
    Lansky SB, List MA, Lansky LL, Ritter-Sterr C, Miller DR (1987) The measurement of performance in childhood cancer patients. Cancer 60(7):1651–1656PubMedCrossRefGoogle Scholar
  15. 15.
    Lassen B, Helseth E, Egge A, Due-Tonnessen BJ, Ronning P, Meling TR (2012) Surgical mortality and selected complications in 273 consecutive craniotomies for intracranial tumors in pediatric patients. Neurosurgery 70(4):936–943, discussion 943PubMedCrossRefGoogle Scholar
  16. 16.
    Lassen B et al (2011) Surgical mortality at 30 days and complications leading to recraniotomy in 2630 consecutive craniotomies for intracranial tumors. Neurosurgery 68(5):1259–1268, discussion 1268–1259PubMedGoogle Scholar
  17. 17.
    Luyken C, Blumcke I, Fimmers R, Urbach H, Elger CE, Wiestler OD, Schramm J (2003) The spectrum of long-term epilepsy-associated tumors: long-term seizure and tumor outcome and neurosurgical aspects. Epilepsia 44(6):822–830PubMedCrossRefGoogle Scholar
  18. 18.
    Musleh W, Yassari R, Hecox K, Kohrman M, Chico M, Frim D (2006) Low incidence of subdural grid-related complications in prolonged pediatric EEG monitoring. Pediatr Neurosurg 42(5):284–287PubMedCrossRefGoogle Scholar
  19. 19.
    Neervoort FW, Van Ouwerkerk WJ, Folkersma H, Kaspers GJ, Vandertop WP (2010) Surgical morbidity and mortality of pediatric brain tumors: a single center audit. Childs Nerv Syst 26(11):1583–1592PubMedCrossRefGoogle Scholar
  20. 20.
    Onal C, Otsubo H, Araki T, Chitoku S, Ochi A, Weiss S, Elliott I, Snead OC 3rd, Rutka JT, Logan W (2003) Complications of invasive subdural grid monitoring in children with epilepsy. J Neurosurg 98(5):1017–1026PubMedCrossRefGoogle Scholar
  21. 21.
    Rabadan AT et al (2007) Factors related to surgical complications and their impact on the functional status in 236 open surgeries for malignant tumors in a Latino-American hospital. Surg Neurol 68(4):412–420, discussion 420PubMedCrossRefGoogle Scholar
  22. 22.
    Riva-Cambrin J, Detsky AS, Lamberti-Pasculli M, Sargent MA, Armstrong D, Moineddin R, Cochrane DD, Drake JM (2009) Predicting postresection hydrocephalus in pediatric patients with posterior fossa tumors. J Neurosurg Pediatr 3(5):378–385PubMedCrossRefGoogle Scholar
  23. 23.
    Sawaya R et al (1998) Neurosurgical outcomes in a modern series of 400 craniotomies for treatment of parenchymal tumors. Neurosurgery 42(5):1044–1055, discussion 1055–1046PubMedCrossRefGoogle Scholar
  24. 24.
    Sharma BS, Sinha S, Mehta VS, Suri A, Gupta A, Mahapatra AK (2007) Pediatric intracranial aneurysms—clinical characteristics and outcome of surgical treatment. Childs Nerv Syst 23(3):327–333PubMedCrossRefGoogle Scholar
  25. 25.
    Smith ER, Butler WE, Barker FG (2004) Craniotomy for resection of pediatric brain tumors in the United States, 1988 to 2000: effects of provider caseloads and progressive centralization and specialization of care. Neurosurgery 54(3):553–563, discussion 563–555PubMedCrossRefGoogle Scholar
  26. 26.
    Valentini LG, Casali C, Chatenoud L, Chiaffarino F, Uberti-Foppa C, Broggi G (2008) Surgical site infections after elective neurosurgery: a survey of 1747 patients. Neurosurgery 62(1):88–95, discussion 95–86PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2012

Authors and Affiliations

  1. 1.Department of NeurosurgeryUniversity Hospital BonnBonnGermany

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