POSTERIOR FOSSA TUMORS IN NEONATES AND INFANTS: SURGICAL IMPLICATIONS AND MID-TERM NEURODEVELOPMENT

Abstract

Introduction: Posterior fossa tumors in neonates and infants represent a neurosurgical challenge due to their critical location, risk of hydrocephalus, and potential neurodevelopmental consequences. Early intervention is vital but can lead to motor, cognitive, and behavioral sequelae. Objective: To evaluate the surgical implications and medium-term neurodevelopmental outcomes in neonates and infants with posterior fossa tumors. Methodology: Systematic review according to the PRISMA guidelines and PICO strategy. Databases: PubMed, Embase, LILACS, and Scopus (2010–2024). Inclusion criteria: studies with patients <2 years old, with posterior fossa tumors, and neurodevelopmental assessment after surgical intervention. A total of 176 studies were identified; after excluding 28 duplicates, 148 remained for screening. Of these, 89 were excluded due to thematic inadequacy and 7 due to conflict of interest. After a complete review of 52 articles, 40 were excluded due to insufficient data, resulting in a total of 12 studies. Results: The included studies demonstrated that, although surgical resection is often effective in increasing survival, approximately 45% to 60% of patients presented neuropsychomotor delay, gait disturbances, and cognitive difficulties in the medium term. Hydrocephalus at diagnosis was present in up to 80% of cases and was associated with higher rates of cognitive sequelae. The need for ventricular shunt correlated with delayed language development. Evidence indicates that, in the postoperative period, early rehabilitation with multidisciplinary support enhances neuroplasticity and favors more satisfactory functional outcomes. Conclusion: Surgical treatment of posterior fossa tumors in children under 2 years of age involves high technical complexity and a significant risk of neurocognitive deficits. The presence of hydrocephalus, age under 12 months at diagnosis, and the histological type directly influence the prognosis. Early and integrated rehabilitation strategies are essential to mitigate the impact on neurodevelopment and improve the quality of life of these patients.