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Purpose <p>Brain tumors are the leading cause of cancer-related death in children, with brain and spine tumors being the most common location for solid tumors in pediatric populations. Postoperative seizures represent a serious, life-altering complication after brain tumor resection (BTR). However, predictors of postoperative seizure risk, particularly regarding patient age and tumor location, remain under-explored.</p> Methods <p>Using the ACS-NSQIP Pediatric database (2012–2023), we identified 6,772 patients ≤ 18-years who underwent BTR, excluding those with preoperative seizure disorders or incomplete data. Age was stratified by empirical quartiles of the study sample Q1 (&lt; 4 years), Q2 (4–8 years), Q3 (8–13 years), and Q4 (13–18 years) to avoid model overfitting and to provide adequate group sizes. Multivariable logistic regression adjusted for clinical and demographic variables was used to identify predictors of postoperative seizures. A decision tree analysis identified the optimal age threshold for seizure risk.</p> Results <p>Of 6,772 patients (median age 8.45 years), 188 (2.8%) experienced postoperative seizures. Younger age significantly predicted seizure risk; each additional year was associated with a 10% reduction in seizure odds (OR: 0.90, 95% CI: 0.88–0.93; <i>p</i> &lt; 0.001). Supratentorial tumor resections had higher seizure risk (OR: 2.98, 95% CI: 2.18–4.09; <i>p</i> &lt; 0.001). Decision tree analysis identified 0.605 years (7.3 months) as a significant age cutoff; patients younger than this were significantly more likely to seize (OR: 11.34, 95% CI: 7.45–17.28; <i>p</i> &lt; 0.001). Postoperative seizures were associated with 30-day complication risk (OR: 6.16, 95% CI: 4.45–8.51; <i>p</i> &lt; 0.001) and mortality (OR: 5.55, 95% CI: 1.14–27.16; <i>p</i> = 0.034).</p> Conclusions <p>Age and tumor location are significant predictors of postoperative seizure risk following pediatric brain tumor resections, with infants under eight months and supratentorial tumor resection experiencing markedly elevated risk. These findings underscore the importance of age-specific seizure risk stratification in clinical decision-making to optimize perioperative management and improve outcomes in pediatric patients undergoing BTR.</p>

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Factors affecting postoperative seizure risk and perioperative outcomes in pediatric brain tumor resections

  • 期刊论文

  • 发表日期：

    2025年12月3日

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  • Omar Sbaih,
  • Aman Singh,
  • Adam Li,
  • Ramana Kolady,
  • Arun Patel,
  • Catherine Jay,
  • Howard Silberstein,
  • Melissa A. LoPresti

摘要

Purpose

Brain tumors are the leading cause of cancer-related death in children, with brain and spine tumors being the most common location for solid tumors in pediatric populations. Postoperative seizures represent a serious, life-altering complication after brain tumor resection (BTR). However, predictors of postoperative seizure risk, particularly regarding patient age and tumor location, remain under-explored.

Methods

Using the ACS-NSQIP Pediatric database (2012–2023), we identified 6,772 patients ≤ 18-years who underwent BTR, excluding those with preoperative seizure disorders or incomplete data. Age was stratified by empirical quartiles of the study sample Q1 (< 4 years), Q2 (4–8 years), Q3 (8–13 years), and Q4 (13–18 years) to avoid model overfitting and to provide adequate group sizes. Multivariable logistic regression adjusted for clinical and demographic variables was used to identify predictors of postoperative seizures. A decision tree analysis identified the optimal age threshold for seizure risk.

Results

Of 6,772 patients (median age 8.45 years), 188 (2.8%) experienced postoperative seizures. Younger age significantly predicted seizure risk; each additional year was associated with a 10% reduction in seizure odds (OR: 0.90, 95% CI: 0.88–0.93; p < 0.001). Supratentorial tumor resections had higher seizure risk (OR: 2.98, 95% CI: 2.18–4.09; p < 0.001). Decision tree analysis identified 0.605 years (7.3 months) as a significant age cutoff; patients younger than this were significantly more likely to seize (OR: 11.34, 95% CI: 7.45–17.28; p < 0.001). Postoperative seizures were associated with 30-day complication risk (OR: 6.16, 95% CI: 4.45–8.51; p < 0.001) and mortality (OR: 5.55, 95% CI: 1.14–27.16; p = 0.034).

Conclusions

Age and tumor location are significant predictors of postoperative seizure risk following pediatric brain tumor resections, with infants under eight months and supratentorial tumor resection experiencing markedly elevated risk. These findings underscore the importance of age-specific seizure risk stratification in clinical decision-making to optimize perioperative management and improve outcomes in pediatric patients undergoing BTR.