Management of hydrocephalus in pediatric patients with posterior fossa tumors: the role of endoscopic third ventriculostomy

Abstract

Third ventriculostomy is feasible even in the presence of posterior fossa tumors (including brainstem tumors). When performed prior to posterior fossa surgery, it significantly reduces the incidence of postoperative hydrocephalus. The procedure provides a valid alternative to placement of a permanent shunt in cases in which hydrocephalus develops following posterior fossa surgery, and it may negate the need for the shunt in cases in which the shunt malfunctions. Furthermore, in patients in whom CSF has caused spread of the tumor at presentation, third ventriculostomy allows chemotherapy to be undertaken prior to tumor excision by controlling hydrocephalus. Although the authors acknowledge that the routine application of third ventriculostomy in selected patients results in a proportion of patients undergoing an "unnecessary" procedure, they believe that because patients' postoperative courses are less complicated and because the incidence of morbidity is low and the success rate is high in those patients with severe hydrocephalus that further investigation of this protocol is warranted.

Management of Hydrocephalus in Children with Posterior Fossa Tumors: Role of Tumor Surgery

“…The main controversy is whether to treat the HC with endoscopic third ventriculostomy (ETV) or not, before primary tumor resection. Sainte-Rose et al[ 3] report that when ETV is performed prior to tumor resection in patients with posterior fossa tumors the incidence of postoperative HC is reduced from 27 to 6%. Persistent or progressive HC after primary tumor resection and no preoperative cerebrospinal fluid (CSF) diversion is reported to occur in 10–62% of cases [1,2,3,4, 6, 8, 9].…”

“…Sainte-Rose et al[ 3] report that when ETV is performed prior to tumor resection in patients with posterior fossa tumors the incidence of postoperative HC is reduced from 27 to 6%. Persistent or progressive HC after primary tumor resection and no preoperative cerebrospinal fluid (CSF) diversion is reported to occur in 10–62% of cases [1,2,3,4, 6, 8, 9]. Thus, the routine application of preoperative ETV in all children with posterior fossa tumors presenting with HC would result in a high proportion of patients undergoing an unnecessary procedure [1, 4, 6].…”

“…These tumors have a predilection for the posterior fossa, and 71–90% of children with posterior fossa tumors have hydrocephalus (HC) at the time of presentation [1,2,3,4,5,6]. …”

Risk of Ventriculoperitoneal Shunt Infections due to Gastrostomy Feeding Tube Insertion in Pediatric Patients with Brain Tumors

“…Children with brain tumors are particularly at risk for inadequate nutrition since their course of treatment could be prolonged and includes surgery, radiotherapy and chemotherapy [1,2,3,4,5,6]. Furthermore, up to 20% of children with primary brain tumors need cerebrospinal fluid (CSF) diversion [7]. Although endoscopic third ventriculostomy has reduced shunting in selected patients, the placement of a ventriculoperitoneal (VP) shunt remains the mainstay in the surgical treatment of hydrocephalus in children with brain tumors [8].…”

Duration of Preoperative External Ventricular Drain in Pediatric Posterior Fossa Tumors—Does It Matter?

“…The use of postoperative VP shunt is the alternative [10]. VP shunt was required in 6% of the patients after ETV for hydrocephalus related to posterior fossa tumor [20].…”