Analysis of Factors Affecting Outcome in Infratentorial Tumor Surgery

Kim, Joo Heon; Choe, Il Seung; Kim, Choong Hyun; Bak, Koang Hum; Kim, Young Soo; Kim, Jae Min; Ko, Yong; Oh, Seong Hoon; Oh, Suck Jun; Kim, Kwang Myung; Kim, Nam Kyu

Abstract

OBJECT: It is well known that infratentorial surgery is more difficult to approach to the lesion and may result in poorer outcome than supratentorial surgery. The prognostic factors and outcome were analyzed for one hundred forty-five consecutive patients who underwent surgical treatment for infratentorial tumor between 1989 and 1997.
METHODS
Neurilemmoma was the most common tumor(41 cases), followed by astrocytoma(19 cases), hemangioblastoma(19 cases), medulloblastoma(18 cases), meningioma(17 cases) respectively. We studied the relationship between postoperative outcome known various factors retrospectively: age at surgery, pathology, duration of symptoms, tumor size, location of tumor, presence of hydrocephalus, and extent of resection. A statistical analysis of clinical characteristics was conducted to evaluate the significance of associations by student t-test. Surgical results were evaluated by Ojemann's method.
RESULTS
Of 145 cases, excellent were in 25 patients, good in 60 patients, fair in 41 patients, poor in 9 patients, and dead in 10 patients. Large size of tumor(p<0.01) and presence of hydrocephalus(p<0.05) were factors that indicate poor outcome. Surgical results of tumors in the cerebellopontine angle(CPA) or clival area were poorer than those in cerebellum(p<0.05). Age, duration of symptom, pathology, and extent of resection did not influence postoperative outcome significantly. The most common postoperative complication was facial palsy(21 cases). The operative mortality was 6.9% and sepsis was the leading cause of death.
CONCLUSION
Large size(p<0.01), presence of hydrocephalus(p<0.05), and location in CPA and clival region(p<0.05) were factors that indicate poor outcome after infratentorial tumor surgery.