Predictive Factors for Postoperative Tracheostomy Requirement in Children Undergoing Surgical Resection of Medulloblastoma

Objective: This study is aimed at identifying factors predicting tracheostomy requirement in children diagnosed with a posterior fossa medulloblastoma postoperatively.

Methods: A retrospective chart review of all patients younger than 18 undergoing medulloblastoma resection from 2012 to 2020 at Namazi Hospital was conducted.

Results: Forty-five patients (26%) needed tracheostomy after the operation. The most common correlates were brainstem compression and absence of gag reflex before operation. Patients who had brainstem compression and infiltration by medulloblastoma, bilateral absence of gag reflex before operation, subtotal resection of the tumor, and postoperative brainstem contusion were more likely to require tracheostomy. No statistically significant difference was observed between males and females and different ages.

Conclusions: Medulloblastoma is the most common pediatric malignancy. Postoperative ventilator dependency is an important complication in postoperative recovery of patients undergoing medulloblastoma resection. Considering the mutism syndrome with all its question marks by means of predisposing factors, we dealt with a 2-week policy whether there would be any clinical resolution regarding patients' gag reflex. The results show that if we aim for total tumor resection, tracheostomy that is a highly costly and stressful postoperative morbidity can be prevented.