Horner syndrome as a complication of neuroblastoma treatment

Neuroblastoma (NBL) is a tumor that develops from sympathetic ganglia and most frequently occurs in young children. In mediastinal and cervical cases, Horner syndrome (HS) may occur as a symptom or a surgical complication. The study aimed to evaluate the factors that influence the occurrence of postsurgical HS. The data concerning the clinical presentation, imaging examinations, performed therapies and treatment outcomes of 454 children with NBL were collected, including 117 cases of thoracic and cervical tumors. The statistical analyses of correlations between postsurgical HS occurrence and different features was performed. HS appeared in 57.89% of patients with tumors adjacent to oculosympathetic pathway. Statistical analyses demonstrated a significant impact of tumor location, patients' age and the duration between the onset of symptoms and the diagnosis on HS incidence as a complication of NBL resection. Neoadjuvant chemotherapy was also associated with a lower incidence of postsurgical HS. The radicality of surgery, the time from diagnosis to the procedure and the used technique did not present any statistically significant association with the occurrence of HS. In conclusion, parents of patients should be informed about the risk of HS in every case of a tumor localized near the oculosympathetic tract. Neoadjuvant chemotherapy might help reduce the risk of postsurgical complications.