CLINICOPATHOLOGICAL FEATURES AND EARLY SURGICAL OUTCOME OF POSTERIOR CRANIAL FOSSA TUMOURS IN CHILDREN AT KENYATTA NATIONAL HOSPITAL (KNH)

Résumé

Objective: To describe clinicopathologic features and early surgical outcome of children managed surgically for PCF tumours in KNH. Methods: Nine-month observational prospective cohort study at Kenyatta National Hospital. Children aged 12 years and below managed surgically at KNH for PCF tumour. Results: Twenty-eight children with PCF tumours were analysed. The mean age was 6.49 years and the male to female ratio was 1:1.33. All the children presented with cerebellar signs and symptoms; features of raised ICP were seen in 96.4% with an average duration before diagnosis of 40 days (1.5 months); motor signs were seen in 75% with a mean duration of 54.1days (2.5 months) before diagnosis; cranial nerve dysfunction was present in 67.9%; 85.7% of the patients had hydrocephalus. The vermis was the most common location of PFT on imaging. Medulloblastoma was the most common radiologic diagnosis and histopathological tumour type at fifty percent and 35.7% respectively. The level of agreement between histopathological diagnosis and radiological diagnosis was 97.4% (p<0.001). Eighty five percent had CSF diversion with majority being VP shunting. Extubation was done in 53.6% of patients post operatively in theatre. Those who had delayed extubation remained intubated for a mean of 11.5 days. The overall mean length of ICU stay was on 10.6 days, patients with delayed extubation had a mean length of ICU stay 18.4 days with those extubated early having a mean ICU stay of 3.8 days. The mean overall length of hospital stay was 24 days. The complication rate was 32.1%. Hydrocephalus was the most common complication at 77.8% followed by wound complications at 22.2%. Young age, less than 4.7 years, duration of hospital stay, and ICU stay were the main risk factors associated with developing complications. The 30-day mortality was 10.7%. Conclusion – This study shows that, more female patients present with PCF in this population. Cerebellar signs and symptoms are the most common pattern of clinical presentation. The symptom duration before diagnosis is long. The most common imaging location is the vermis with medulloblastoma being is the most common radiological and histological tumour type. Long stay in ICU and long admission duration are associated with increased complication occurrence.