Complicaciones graves en cirugía neurológica de alta complejidad en pacientes pediátricos: revisión sistemática conforme a PRISMA 2020
DOI:
https://doi.org/10.5281/zenodo.22325915Palabras clave:
morbilidad quirúrgica, cuidados intensivos, eventos adversos, neuroanestesia, seguridad perioperatoriaResumen
La cirugía neurológica pediátrica de alta complejidad exige controlar riesgos derivados de la inmadurez fisiológica, la localización anatómica y la naturaleza del procedimiento. El objetivo fue analizar sistemáticamente las complicaciones graves perioperatorias y posoperatorias, sus factores asociados y las estrategias preventivas en pacientes menores de 18 años. Se desarrolló una revisión sistemática con síntesis cualitativa conforme a PRISMA 2020, utilizando el documento base y una actualización bibliográfica verificable en literatura biomédica indexada hasta 2026, sin combinar estadísticamente resultados heterogéneos. La evidencia mostró perfiles diferenciados: 3,5 % de complicaciones intraoperatorias en una serie de 1.807 procedimientos, 9,8 % de eventos en craneosinostosis, 8,39 % de déficit neurológico persistente tras cirugía tumoral en una cohorte y reducción del riesgo de infección con derivaciones impregnadas con antibióticos. La edad temprana, la cirugía prolongada, la pérdida sanguínea, la localización infratentorial, la manipulación vascular, las comorbilidades y la posición quirúrgica modificaron el riesgo. Se concluyó que la seguridad depende de prevención multimodal, neuroanestesia especializada, estandarización de resultados y vigilancia posoperatoria intensiva.
Descargas
Referencias
1. World Health Organization. Global patient safety action plan 2021-2030: towards eliminating avoidable harm in health care. Geneva: World Health Organization; 2021.
2. Drake JM, Singhal A, Kulkarni AV, deVeber G, Cochrane DD; Canadian Pediatric Neurosurgery Study Group. Consensus definitions of complications for accurate recording and comparisons of surgical outcomes in pediatric neurosurgery. J Neurosurg Pediatr. 2012;10(2):89-95. doi:10.3171/2012.3.PEDS11233.
3. van Lindert EJ, Arts S, Blok LM, Hendriks MP, Tielens L, van Bilsen M, et al. Intraoperative complications in pediatric neurosurgery: review of 1807 cases. J Neurosurg Pediatr. 2016;18(3):363-371. doi:10.3171/2016.3.PEDS15679.
4. Kuo BJ, Vissoci JRN, Egger JR, Smith ER, Grant GA, Haglund MM, et al. Perioperative outcomes for pediatric neurosurgical procedures: analysis of the National Surgical Quality Improvement Program-Pediatrics. J Neurosurg Pediatr. 2017;19(3):361-371. doi:10.3171/2016.10.PEDS16414.
5. Lenga P, Issa M, Abushamsieh H, Zittel S, Engel M, Scherer M, et al. Prospective insights into pediatric neurosurgery: transforming care through adverse event analysis. J Neurosurg Pediatr. 2025;36(3):369-378. doi:10.3171/2025.2.PEDS24508.
6. Middelkamp M, Drexler R, Groth FS, Sauvigny T, Ricklefs FL, Kammler G, et al. Evaluation of intraoperative adverse events and perioperative outcomes in pediatric neurosurgery. World Neurosurg. 2025;203:124434. doi:10.1016/j.wneu.2025.124434.
7. Radu OM, Balaci GM, Leucuta DC, Florian IS. Exploring anesthesia-related complications in pediatric neurosurgery: a comparative analysis of the sitting and park-bench positions. Med Pharm Rep. 2024;97(4):540-548. doi:10.15386/mpr-2788.
8. Bashiryan BA, Satanin LA, Gadzhieva OA, Danilov GV, Strunina YV, Kokaeva IK, et al. Perioperative complications in surgery for craniosynostosis in children: a systematic review and meta-analysis. Zh Vopr Neirokhir Im N N Burdenko. 2025;89(3):114-121. doi:10.17116/neiro202589031114.
9. Foster MT, Hennigan D, Grayston R, van Baarsen K, Sunderland G, Millward CP, et al. Reporting morbidity associated with pediatric brain tumor surgery: are the available scoring systems sufficient? J Neurosurg Pediatr. 2021;27(5):556-565. doi:10.3171/2020.9.PEDS20556.
10. Henriksen KA, Brix N, Jakubauskaite R, von Oettingen G, Rathe M, Skjoth-Rasmussen J, et al. Thirty-day surgical morbidity and risk factors in pediatric brain tumor surgery: a 10-year nationwide retrospective study. J Neurosurg Pediatr. 2024;33(2):165-173. doi:10.3171/2023.9.PEDS23351.
11. Sletvold TP, Boland S, Schipmann S, Mahesparan R. Quality indicators for evaluating the 30-day postoperative outcome in pediatric brain tumor surgery: a 10-year single-center study and systematic review of the literature. J Neurosurg Pediatr. 2023;31(2):109-123. doi:10.3171/2022.10.PEDS22308.
12. Campbell E, Todd L, Amato-Watkins A, O'Kane R, Sangra M, Canty M. Prospective review of 30-day morbidity and mortality following surgery for brain tumours in children. Childs Nerv Syst. 2025;41(1):162. doi:10.1007/s00381-025-06817-1.
13. Pettersson SD, Kitlinski M, Miekisiak G, Ali S, Krakowiak M, Szmuda T. Risk factors for postoperative cerebellar mutism syndrome in pediatric patients: a systematic review and meta-analysis. J Neurosurg Pediatr. 2022;29(4):467-475. doi:10.3171/2021.11.PEDS21445.
14. Salman A, Fahim MAA, Sohail A, Bashir HH, Haizel-Cobbina J, Dewan MC, et al. Pre-operative and intra-operative risk factors of post-operative cerebellar mutism syndrome in pediatric patients undergoing posterior fossa tumor surgery: a systematic review. Childs Nerv Syst. 2026;42(1):36. doi:10.1007/s00381-025-07109-4.
15. Horne BM, Attanayake AA, Aquilina K, Murphy T, Malcolm CP. Neurocognitive outcomes following postoperative paediatric cerebellar mutism syndrome: a systematic review. Dev Med Child Neurol. 2026;68(1):29-48. doi:10.1111/dmcn.16483.
16. Chisolm PF, Warner JD, Hale AT, Estevez-Ordonez D, Murdaugh D, Rozzelle CJ, et al. Quantifying and reporting outcome measures in pediatric epilepsy surgery: a systematic review. Epilepsia. 2022;63(11):2754-2781. doi:10.1111/epi.17369.
17. Romanowski EF, McNamara N. Surgery for intractable epilepsy in pediatrics, a systematic review of outcomes other than seizure freedom. Semin Pediatr Neurol. 2021;39:100928. doi:10.1016/j.spen.2021.100928.
18. Kolosky T, Goldstein Shipper A, Sun K, Tozduman B, Bentzen S, Moosa AN, et al. Epilepsy surgery for children with epileptic spasms: a systematic review and meta-analysis with focus on predictors and outcomes. Epilepsia Open. 2024;9(4):1136-1147. doi:10.1002/epi4.13007.
19. Makridis KL, Atalay DA, Thomale UW, Tietze A, Elger CE, Kaindl AM. Epilepsy surgery in the first six months of life: a systematic review and meta-analysis. Seizure. 2022;96:109-117. doi:10.1016/j.seizure.2022.02.009.
20. Frank NA, Greuter L, Guzman R, Soleman J. Early surgical approaches in pediatric epilepsy - a systematic review and meta-analysis. Childs Nerv Syst. 2023;39(3):677-688. doi:10.1007/s00381-022-05699-x.
21. Konrad E, Robinson JL, Hawkes MT. Cerebrospinal fluid shunt infections in children. Arch Dis Child. 2023;108(9):693-697. doi:10.1136/archdischild-2022-324559.
22. Qiu Y, Wu Y. Efficacy of antibiotic-impregnated shunt versus conventional shunts to reduce cerebrospinal fluid infections in children: a systematic review and meta-analysis. Exp Ther Med. 2020;20(4):3775-3781. doi:10.3892/etm.2020.9122.
23. Zhou WX, Hou WB, Zhou C, Yin YX, Lu ST, Liu G, et al. Systematic review and meta-analysis of antibiotic-impregnated shunt catheters on anti-infective effect of hydrocephalus shunt. J Korean Neurosurg Soc. 2021;64(2):297-308. doi:10.3340/jkns.2019.0219.
24. Wathoni RTZ, Suryaningtyas W, Utomo B, Parenrengi MA, Turchan A, Fauzi AA. Risk factors for cerebrospinal fluid shunt infection in pediatrics: a meta-analysis. Surg Neurol Int. 2025;16:16. doi:10.25259/SNI_848_2024.
25. Minta KJ, Kannan S, Kaliaperumal C. Outcomes of endoscopic third ventriculostomy and ventriculoperitoneal shunt in the treatment of paediatric hydrocephalus: systematic review and meta-analysis. Childs Nerv Syst. 2024;40(4):1045-1052. doi:10.1007/s00381-023-06225-3.
26. Castillo-Huerta NM, Torres-Garcia ON, Vargas Aymituma A. Postoperative complications of ventriculoperitoneal shunt in children: experience from a middle-income referral hospital in Lima, Peru. Childs Nerv Syst. 2025;41(1):342. doi:10.1007/s00381-025-06971-6.
27. Sherrod BA, Rocque BG. Morbidity associated with 30-day surgical site infection following nonshunt pediatric neurosurgery. J Neurosurg Pediatr. 2017;19(4):421-427. doi:10.3171/2016.11.PEDS16455.
28. Sherrod BA, Arynchyna AA, Johnston JM, Rozzelle CJ, Blount JP, Oakes WJ, et al. Risk factors for surgical site infection following nonshunt pediatric neurosurgery: a review of 9296 procedures from a national database and comparison with a single-center experience. J Neurosurg Pediatr. 2017;19(4):407-420. doi:10.3171/2016.11.PEDS16454.
29. Naik S, Nirale A, Bharadwaj S, Sangeetha RP, Shukla D, Kamath S. Post-operative anemia in children undergoing elective neurosurgery: an analysis of incidence, risk factors, and outcomes. J Neurosci Rural Pract. 2024;15(1):29-33. doi:10.25259/JNRP_338_2023.
30. World Health Organization. Implementation manual WHO surgical safety checklist 2009: safe surgery saves lives. Geneva: World Health Organization; 2009.
31. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71. doi:10.1136/bmj.n71.
32. Page MJ, Moher D, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. PRISMA 2020 explanation and elaboration: updated guidance and exemplars for reporting systematic reviews. BMJ. 2021;372:n160. doi:10.1136/bmj.n160.
33. Moore R, Pfershy H, Pletcher J, Boville B, Girotto JA, Carlson AR. Effective pediatric blood management in craniosynostosis surgery: a long-term update. J Craniofac Surg. 2025;36(1):111-114. doi:10.1097/SCS.0000000000010682.
34. Varidel A, Marucci D. Tranexamic acid in craniosynostosis surgery: a systematic review and meta-analysis. J Craniofac Surg. 2022;33(1):146-150. doi:10.1097/SCS.0000000000008123.
35. Zapata-Copete JA, Gomez-Ospina JC, Garcia-Perdomo HA, Caycedo DJ. Role of tranexamic acid in craniosynostosis surgery: systematic review and meta-analysis. J Plast Reconstr Aesthet Surg. 2022;75(4):1389-1398. doi:10.1016/j.bjps.2021.11.064.
36. Alabdulkarim A, Al Qurashi AA, Odeh NB, Hashemi ASA, Arbili LM, AlSwealh MS, et al. Effect of tranexamic acid on the reduction of blood loss in craniosynostosis surgery: a systematic review and meta-analysis. Plast Reconstr Surg Glob Open. 2023;11(6):e5021. doi:10.1097/GOX.0000000000005021.
37. Ahmadian N, van Baarsen KM, Robe PAJT, Hoving EW. Association between cerebral perfusion and paediatric postoperative cerebellar mutism syndrome after posterior fossa surgery - a systematic review. Childs Nerv Syst. 2021;37(9):2743-2751. doi:10.1007/s00381-021-05225-5.
38. Svaldi C, Ntemou E, Jonkers R, Kohnen S, de Aguiar V. Language outcomes in children who underwent surgery for the removal of a posterior fossa tumor: a systematic review. Eur J Paediatr Neurol. 2024;48:129-141. doi:10.1016/j.ejpn.2023.12.005.
39. Darko K, Guirguis M, Kakulamarri S, Farid M, Venkatesh P, Osei Adjei EK, et al. Presentation, management, and outcomes of pediatric hydrocephalus in Africa: a systematic review and meta-analysis of 12,355 patients. J Neurosurg Pediatr. 2024;34(4):315-327. doi:10.3171/2024.5.PEDS23595.
40. Ferris E, Kynaston J, Dalle DU, Ng YJ, Leahy P, Hassan U, et al. The etiology of pediatric hydrocephalus across Asia: a systematic review and meta-analysis. J Neurosurg Pediatr. 2024;33(4):323-333. doi:10.3171/2023.11.PEDS23389.
