Integrated Diagnostic and Surgical Management of Pediatric CNS Tumors: A Single-Centre Prognostic Analysis

<b>Backgroud/Objectives:</b> Pediatric central nervous system (CNS) tumors represent the second most common oncological disease in children. The purpose of this research was to analyze the course of surgical treatment for these tumors at the University Medical Centre Ljubljana between October 2018 and December 2025. <b>Methods:</b> A retrospective analysis of 110 patients was conducted, focusing on diagnostic accuracy and its correlation with surgical and neurological outcomes. <b>Results:</b> Over a seven-year period, 110 children were surgically treated, undergoing a total of 130 operative procedures. A calculated annual incidence of 3.8 cases per 100,000 was identified. The most common initial symptoms were headache (36.3%), vomiting (20%), and ataxia (17.2%). Tumors were localized supratentorially in 52.7% of cases, infratentorially in 30%, and along the spinal canal in 13.6%. The most frequent histopathological types were pilocytic astrocytomas/paediatric-type diffuse low-grade gliomas (18.1%), medulloblastomas (14.5%), and craniopharyngiomas (7.2%). Gross total resection was achieved in 60% of all procedures. Surgical complications occurred in 10.6% of cases, with a surgical mortality rate of 0.9%. Neurological deterioration occurred in 27.2% of cases, most commonly in the form of cerebellar mutism (8.1%). Diagnostic histology of medulloblastoma and infratentorial anatomical location were confirmed as critical prognostic markers for cerebellar mutism (<i>p</i> < 0.011) and shunt dependency (<i>p</i> = 0.0121). <b>Conlcusions:</b> This study confirms that treatment outcomes in the Slovenian tertiary center are comparable to international standards. Integrative diagnostic strategies significantly refine surgical planning and prognostic assessment, optimizing long-term morbidity management.