Hydrocephalus in children with posterior fossa tumors: role of endoscopic third ventriculostomy

Abstract

For children with posterior fossa tumors, ETV is not indicated as a standard operation either prior to or following tumor removal. Only six of 52 children presenting with hydrocephalus required a permanent CSF draining procedure. Endoscopic third ventriculostomy may be suitable for patients with fourth ventricle outflow obstruction and persisting or progressive hydrocephalus following tumor removal.

Endoscopic third ventriculostomy in the management of hydrocephalus: Outcome analysis of 168 consecutive procedures

“…The role of ETV is well established, and its success in the treatment of obstructive hydrocephalus due to intracranial tumours is recognised both in paediatric patients (as described in recent articles by Wong et al [78], Di Rocco et al [79], and other authors [21,[80][81][82]) and adults [83,84].…”

Endoscopy in Intracranial Pathology

“…In one study where patients with hydrocephalus and posterior fossa tumors either received ETV before resective surgery or conventional management, ETV dropped the need for a shunt from 20% to 6% (SainteRose et al, 2001). Other authors confirm that ETV is an efficient procedure for controlling hydrocephalus associated with posterior fossa tumors, but find that the low rate of persistent hydrocephalus after tumor removal (9-12%) does not justify adopting routine preoperative third ventriculostomies (Fritsch et al, 2005;Morelli et al, 2005). Despite being successful, the two ETV procedures done before microsurgical resection in our previously reported series do not provide sufficient evidence to support performing ETV as a routine preoperative procedure (Najjar et al, 2010).…”

Cerebrospinal fluid disturbances after 381 consecutive craniotomies for intracranial tumors in pediatric patients

“…Furthermore, 15.3% of children who showed hydrocephalus on their admission CT scan underwent postoperative shunt placement, producing a shunt-free treatment success rate of 84.7%. In another similar study by Fritsch et al, 12 46 (88.5%) of 52 patients did not require permanent CSF diversion (neither VP shunt placement nor EVD/ETV). We report a similar high postoperative shunt-free success rate of 86.6% after tumor resection only (Fig.…”

“…Other risk factors for permanent hydrocephalus included low preoperative Karnofsky Performance Scale scores, infratentorial surgery (40.4% vs 2.6% for supratentorial surgeries), intraaxial or subdural surgery, and emergency surgery. Other patient series have postoperative hydrocephalus rates ranging from 10% to 35%, 3,4,12,22,25,33 although these series are restricted to posterior fossa tumors. The overall rate of postoperative hydrocephalus with subsequent VP shunt placement in our study is relatively low, even though we included all patients regardless of tumor location and state of preoperative hydrocephalus.…”