Implantation of VPS in the early postoperative period following removal of posterior cranial fossa tumors in children

Chel'diev, B Z; Kushel, Yu V; Demin, M O

doi:10.17116/neiro201882481

Cited by 3 publications

(4 citation statements)

References 17 publications

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“…According to the outcomes of 117 patients who underwent direct tumor resection in this study, the recurrence rate of hydrocephalus was as high as 20.5%, and the shortest duration was only 7 days. A retrospective study in 2018 found that the recurrence rate after direct resection of tumors in midline regions, such as posterior fossa tumors, in children was 8.4% [3], and this rate was even over 25% in other reports [21] .…”

Section: Discussionmentioning

confidence: 98%

“…It has been reported in the literature that intraventricular hemorrhage is the most common cause of acquired hydrocephalus in infants, including premature babies. After this period, tumors become the most frequent etiology of acquired hydrocephalus, especially midline tumors in the fourth ventricle [2,3,10]. These tumors obstruct the CSF circulation, leading to acquired hydrocephalus, and therefore, this condition is classi ed as obstructive hydrocephalus.…”

Section: Discussionmentioning

confidence: 99%

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Treatments for obstructive hydrocephalus secondary to malignant midline intracranial tumors during the perioperative period — a retrospective study of 372 pediatric patients from a single institution

Ou¹,

Fan²,

Liu³

et al. 2021

Preprint

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Objective Common treatments for obstructive hydrocephalus caused by malignant midline intracranial tumors during the perioperative period include ventriculoperitoneal shunt (VPS) placement/endoscopic third ventriculostomy (ETV) and direct tumor resection, but which of these treatments is superior remains unclear. The purpose of this study is to explore the management of hydrocephalus during the perioperative period and subsequent outcomes. Methods Data from 372 patients with obstructive hydrocephalus due to malignant midline intracranial tumors under the age of 18 years referred to the Department of Pediatric Neurosurgery at Beijing Tiantan Hospital between January 2018 and September 2019 were collected. We also collected their clinical features and outcomes for further statistical analysis. Results A total of 372 pediatric patients were treated for obstructive hydrocephalus. In total, 215 patients underwent preoperative VPS placement; the effectiveness of preoperative VPS placement was 98.1% (211/215), and the mean duration of relapse was 63.5 ± 15.7 days. Forty children underwent ETV before tumor removal; the effectiveness of preoperative ETV was 90.0% (36/40), and the mean duration of relapse was 53.8 ± 44.9 days. A total of 117 patients underwent direct tumor resection after being diagnosed; the recurrence rate of hydrocephalus was 20.5% (24/117), and the mean duration of relapse was 125.0 ± 170.8 days. There was a significant difference between preoperative VPS placement followed by resection and postoperative VPS placement and preoperative ETV followed by resection and postoperative VPS placement (p = 0.013). Conclusion Malignant midline intracranial tumors in pediatric patients usually lead to obstructive hydrocephalus, and preoperative intervention for hydrocephalus (VPS or ETV) will improve patient outcomes. The optimal management strategy for obstructive hydrocephalus due to malignant midline intracranial tumors is preoperative VPS placement or ETV due to their low hydrocephalic recurrence rates and high effectiveness.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Treatments for obstructive hydrocephalus secondary to malignant midline intracranial tumors during the perioperative period — a retrospective study of 372 pediatric patients from a single institution

Ou¹,

Fan²,

Liu³

et al. 2021

Preprint

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“…In children with brainstem or posterior fossa gliomas, 80-90% have been reported to develop hydrocephalus [17,18]. In adults, the incidence of CH following surgery appears to be lower than 10% in GBM [15,16,[19][20][21]. For lower-grade gliomas, this has not been established, and it is unclear whether the risk for postoperative CH in glioma patients is related to the WHO grade.…”

Section: Introductionmentioning

confidence: 99%

Postoperative Communicating Hydrocephalus Following Grade 2/3 Glioma Resection: Incidence, Timing and Risk Factors

Hönikl

Lange

Meyer

et al. 2023

Cancers

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Background: In diffusely infiltrating gliomas, the maximum extent of tumor resection is an important predictor of overall survival, irrespective of histological or molecular subtype or tumor grade. For glioblastoma WHO grade 4 (GBM), it has been shown that resection-related events, such as ventricular opening and ventriculitis, increase the risk for development of communicating hydrocephalus (CH) requiring cerebrospinal fluid (CSF) diversion surgery. Risk factors for the development and the incidence of hydrocephalus following resection of other types of infiltrating gliomas are less well established. In this study, we evaluated the incidence and timing of occurrence of different types of hydrocephalus and potential risk factors for the development of CH following resection of grade 2 and 3 gliomas. Methods: 346 patients who underwent tumor resection (WHO grade 2: 42.2%; 3: 57.8%) at our department between 2006 and 2019 were analyzed retrospectively. For each patient, age, sex, WHO grade, histological type, IDH mutation and 1p/19q codeletion status, tumor localization, number of resections, rebleeding, ventriculitis, ventricular opening during resection and postoperative CSF leak were determined. Uni- as well as multivariate analyses were performed to identify associations with CH and independent risk factors. Results: 24 out of 346 (6.9%) patients needed CSF diversion surgery (implantation of a ventriculoperitoneal or ventriculoatrial shunt) following resection. Nineteen patients (5.5%) had CH, on median, 44 days after the last resection (interquartile range: 18–89 days). Two patients had obstructive hydrocephalus (OH), and three patients had other CSF circulation disorders. CH was more frequent in grade 3 compared to grade 2 gliomas (8.5 vs. 1.4%). WHO grade 3 (odds ratio (OR) 7.5, p = 0.00468), rebleeding (OR 5.0, p = 0.00984), ventriculitis (OR 4.1, p = 0.00463) and infratentorial tumor localization (OR 6.6, p = 0.00300) were identified as significant independent risk factors for the development of post-resection CH. Ventricular opening was significantly associated with CH, but it was not an independent risk factor. Conclusion: Physicians treating brain tumor patients should be aware that postoperative CH requiring CSF shunting occurs not only in GBM but also after resection of lower-grade gliomas, especially in grade 3 tumors. It usually occurs several weeks after resection. Rebleeding and postoperative ventriculitis are independent risk factors.

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“…In adults, the incidence of CH following GBM resection appears to be lower than 10% ( 16 , 17 , 19 , 20 ). Reported risk factors are ventricular opening during tumor resection ( 16 ), leptomeningeal tumor spread ( 17 ), and the number of pre-shunt craniotomies ( 21 ).…”

Section: Introductionmentioning

confidence: 99%

Postoperative communicating hydrocephalus following glioblastoma resection: Incidence, timing and risk factors

et al. 2022

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IntroductionGlioblastoma (GBM) is the most common malignant primary brain tumor. Treatment includes maximally safe surgical resection followed by radiation and/or chemotherapy. However, resection can lead to ventricular opening, potentially increasing the risk for development of communicating hydrocephalus (CH). Complications such as rebleeding and infection may also lead to CH and, eventually, the need for cerebrospinal fluid (CSF) diversion surgery. In this study, we evaluated the incidence of different types of hydrocephalus and potential risk factors for the development of CH following glioblastoma resection.Methods726 GBM patients who underwent tumor resection at our department between 2006 and 2019 were analyzed retrospectively. Potential risk factors that were determined for each patient were age, sex, tumor location, the number of resection surgeries, ventricular opening during resection, postoperative CSF leak, ventriculitis, and rebleeding. Uni- as well as multivariate analyses were performed to identify associations with CH and independent risk factors.Results55 patients (7.6%) needed CSF diversion surgery (implantation of a ventriculoperitoneal or ventriculoatrial shunt) following resection surgery. 47 patients (6.5%) had CH, on median, 24 days after the last resection (interquartile range: 17-52 days). 3 patients had obstructive hydrocephalus (OH) and 5 patients had other CSF circulation disorders. Ventricular opening (odds ratio (OR): 7.9; p=0.000807), ventriculitis (OR 3.3; p=0.000754), and CSF leak (OR 2.3; p=0.028938) were identified as significant independent risk factors for the development of post-resection CH. Having more than one resection surgery was associated with CH as well (OR 2.1; p=0.0128), and frontal tumors were more likely to develop CH (OR 2.4; p=0.00275), while temporal tumors were less likely (OR 0.41; p=0.0158); However, none of those were independent risk factors. Age, sex, or rebleeding were not associated with postoperative CH.ConclusionPostoperative CH requiring CSF shunting is not infrequent following GBM resection and is influenced by surgery-related factors. It typically occurs several weeks after resection. If multiple risk factors are present, one should discuss the possibility of postoperative CH with the patient and maybe even consider pre-emptive shunt implantation to avoid interruption of adjuvant tumor therapy. The incidence of CH requiring shunting in GBM patients could rise in the future.

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Implantation of VPS in the early postoperative period following removal of posterior cranial fossa tumors in children

Cited by 3 publications

References 17 publications

Treatments for obstructive hydrocephalus secondary to malignant midline intracranial tumors during the perioperative period — a retrospective study of 372 pediatric patients from a single institution

Treatments for obstructive hydrocephalus secondary to malignant midline intracranial tumors during the perioperative period — a retrospective study of 372 pediatric patients from a single institution

Postoperative Communicating Hydrocephalus Following Grade 2/3 Glioma Resection: Incidence, Timing and Risk Factors

Postoperative communicating hydrocephalus following glioblastoma resection: Incidence, timing and risk factors

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