PDNO-07 SURGICAL MANAGEMENT AND EARLY OUTCOME OF PAEDIATRIC POSTERIOR FOSSA PILOCYTIC ASTROCYTOMAS: A TWO-CENTER EXPERIENCE

Abstract

Abstract Introduction Posterior fossa pilocytic astrocytomas (PACs) are the commonest paediatric posterior fossa tumours. Delayed presentation, increased morbidity and mortality are common in Sub-Saharan Africa. Objective This study aims to analyze the clinical presentation and surgical outcomes of children with posterior fossa PACs in two institutions in Nigeria: University College Hospital, Ibadan and Uthman Danfodio Teaching Hospital, Sokoto. Methodology This was a retrospective study of 40 children in Nigeria, who were surgically managed for posterior fossa PACs, from January 2016 to January 2023 and had clinical records with desired data. Data on demographics, clinical and radiologic presentations, extent of resection (EOR) and outcome at 3months and 6months, were collated and analyzed using SPPS version 23. Results There were 19 males and 21 females, giving an M: F ratio of 0.9: 1. The mean age was 7.9 ± 0.5 years. All patients presented with poor vision and ataxia, 39 presented with headache while 36 presented with vomiting. The mean duration of symptoms was 6.5 ± 0.6 months. Baseline Karnofsky’s performance status (KPS) was ≥ 80% in 15 patients. 26 patients had hemispheric lesions while the rest were vermian or ventricular. Most lesions appeared as mixed cystic and solid lesions, with 4 mainly solid lesions. The mean duration from presentation to surgery was 1.0 ± 0.1 months. Preoperative cerebrospinal fluid (CSF) diversion via ventriculoperitoneal shunt was done in 28 (70%) patients. Gross total resection (GTR) was achieved in 32 (80%) of the patients. Post-operative CSF leak occurred in 2 patients; 2 had meningitis and 1 had surgical site infection. 1 mortality was recorded. 29 patients who had GTR had a KPS ≥ 80% at 3months while 3 who had a STR had a KPS ≥80%. At 6months, the number was 30 and 3, respectively. Conclusion The EOR improves early outcome in surgically managed paediatric posterior fossa PACs.