Management of Posterior Fossa Tumors in Adults Based on the Predictors of Postoperative Hydrocephalus

Zhang, Chengda; Zhang, Tingbao; Ge, Lingli; Chen, Jincao

doi:10.3389/fsurg.2022.886438

Cited by 6 publications

(4 citation statements)

References 45 publications

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“…There are several possible reasons to explain the role of lesion size. Corroborated with the previous works, the inherent characteristics of the surgery, longer operative times, more perioperative bleeding, more irritation of the ventricular surfaces, or more spillage of neoplasms cells or a combination of these factors, could have contributed to the condition [4,6,9,21,[23][24][25][26]. Second, causation can be speculated to growth kinetics.…”

Section: Discussionmentioning

confidence: 80%

“…The ventricular in ltration could represent a signi cant indicator for hydrocephalus risk strati cation of patients with medulloblastoma at the point of postresection. Three previous studies have investigated the association between ventricular in ltration and necessitating permanent shunt [23,25,26]. The chronic or late-onset symptomatic persistent hydrocephalus after resection could be driven by a direct effect of medulloblastoma and might be explained by several hypotheses, including obstructive and noncommunicating.…”

Section: Discussionmentioning

confidence: 99%

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Incidence and risk factors for necessitating shunting following medulloblastoma surgery in Children: a monocenter, retrospective, observational cohort study

Zhang

Zhai

et al. 2022

Preprint

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Purpose: There have been insufficient data for pediatric patients with medulloblastoma who necessitate shunting following resection. This study aims to determine which characters are associated with the incidence in this patient subset. Methods: We surveyed this monocenter, retrospective, observational cohort of patients (aged 18 years or younger) who underwent medulloblastoma resection at our department between July 1, 2010, to August 1, 2021. The primary outcome was the incidence of necessitating permanent shunt censored after medulloblastoma surgery. Subject demographic, tumor biology, and interventions were analyzed using univariate and multivariable adjusted models. Results: 183 patients were admitted to our department. Of these, 131 (71·6%) patients participated. The incidence of necessitating permanent shunt was 25.6% (95% CI: 18.7-34.3). Factors that were independently associated with the incidence were medulloblastoma volume > 46381.5mm3 (OR: 2.919, 95% CI: 1.191-7.156) and ventricular infiltration (OR: 2.849, 95% CI: 1.142-7.102). Manifestations duration could be a covariate of tumor volume and increased risk of shunt need (OR: 1.006, 95% CI: 1.000-1.013). Besides, tumor volume was a probable predictor in patients with subtotal resection (OR: 4.900, 95% CI: 0.992-24.208, P=0.051). Lastly, there was no significant difference between the distribution of molecular subgroups for necessitating permanent shunt patients. Conclusion: Increased incidence was associated with medulloblastoma invasion. Our study implies that the presence of postresection hydrocephalus in patients with medulloblastoma was not high enough to entail a prophylactic permanent shunt in all patients.

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Section: Discussionmentioning

confidence: 80%

Section: Discussionmentioning

confidence: 99%

Incidence and risk factors for necessitating shunting following medulloblastoma surgery in Children: a monocenter, retrospective, observational cohort study

Zhang

Zhai

et al. 2022

Preprint

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“…Our results are in line with the findings from studies that have explored the outcomes of adult PF resection with the operating microscope. Zhang et al 23 observed the management of 675 adult patients with PF tumors where surgeons were able to achieve GTR in 96.7% of patients. In addition, they reported a 3.6% and 3.9% incidence of postoperative hydrocephalus and hemorrhage, respectively.…”

Section: Discussionmentioning

confidence: 99%

Application of the Robotic-Assisted Digital Exoscope for Resection of Posterior Fossa Tumors in Adults: A Series of 45 Cases

Price,

Schupper,

Kalagara

et al. 2023

Operative Neurosurgery

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BACKGROUND AND OBJECTIVES: Complete safe resection is the goal when pursuing surgical treatment for posterior fossa (PF) tumors. Efforts have led to the development of the exoscope that delineates tumors from non-neoplastic brain. This investigation aims to assess patient outcomes where PF tumor resection is performed with the exoscope by a retromastoid or suboccipital approach. METHODS: A retrospective analysis was conducted for patients with PF tumors who underwent exoscope resection from 2017 to 2022. Patient demographics, clinical, operative, and outcome findings were collected. Extent of resection studies were also performed. Associations between perioperative data, discharge disposition, progression-free survival (PFS), and overall survival (OS) were evaluated. RESULTS: A total of 45 patients (22 male patients) with a median age of 57 years were assessed. Eighteen (40%) and 27 patients (60%) were diagnosed with malignant and benign tumors, respectively. Tumor neurovascular involvement was found in 28 patients (62%). Twenty-four (53%) and 20 (44%) tumors formed in the cerebellum and cerebellopontine angle cistern, respectively. One tumor (2%) was found in the cervicomedullary junction. The mean extent of resection was 96.7% for benign and malignant tumors. The PFS and OS rate at 6 months (PFS6, OS6) was 89.7% and 95.5%, respectively. Neurological complications included sensory loss and motor deficit, with 11 patients reporting no postoperative symptoms. Of the neurological complications, 14 were temporary and 9 were permanent. CONCLUSION: The exoscope is an effective intraoperative visualization tool for delineating PF tumors. In our series, we achieved low postoperative tumor volumes and a high gross total resection rate.

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“…The Kendall tau correlation coefficient between GOS and KPI. KPI = Karnofsky Performance Index; GOS = Glasgow Outcome Score a rate of hydrocephalus after posterior fossa surgery to be 2% to 7% in adult patients 13 .…”

Section: Discussionmentioning

confidence: 99%

Clinical and Surgical Characteristics of Posterior Fossa Tumors in Adults – Single-Center Experience of Surgical Management

Janković

2023

ACC

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In contrast to tumors in children, between 6% and 20% of all brain tumors in adults arise solitary in the posterior cranial fossa. Given their rarity in adults, as well as the importance and complexity of their treatment, this paper reviews and discusses the clinical and surgical characteristics of such tumors. In a retrospective single-institution observational study, adult patients with posterior fossa tumors treated surgically over a ten-year period were analyzed. The characteristics observed were age and gender distribution, clinical symptoms, histopathologic tumor type, tumor size, location and extent of surgical resection, tumor recurrence and postoperative complications, as well as surgical outcome. Sixty-six patients who underwent surgical treatment were diagnosed with a tumor in the posterior fossa. The mean age was 63 years, and patients were evenly distributed by gender. The most common histopathologic type was metastatic tumor (59.1%), whereas meningioma was the most common primary brain tumor (16.6%) recorded. Most patients presented with vegetative and cerebellar symptoms in general and cranial nerve palsy, especially in the occurrence of vestibular schwannoma. In conclusion, posterior fossa tumors grow in a confined space and therefore may directly threaten vital centers in their immediate vicinity. Thus, it is crucial to schedule an appropriate surgical intervention as soon as possible, as it can significantly improve treatment outcome and prognosis of the disease. If possible, meticulous total tumor resection should be the treatment of choice. In the case of hydrocephalus, a ventriculoperitoneal shunt should be considered as an alternative surgical option after tumor resection.

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Management of Posterior Fossa Tumors in Adults Based on the Predictors of Postoperative Hydrocephalus

Cited by 6 publications

References 45 publications

Incidence and risk factors for necessitating shunting following medulloblastoma surgery in Children: a monocenter, retrospective, observational cohort study

Incidence and risk factors for necessitating shunting following medulloblastoma surgery in Children: a monocenter, retrospective, observational cohort study

Application of the Robotic-Assisted Digital Exoscope for Resection of Posterior Fossa Tumors in Adults: A Series of 45 Cases

Clinical and Surgical Characteristics of Posterior Fossa Tumors in Adults – Single-Center Experience of Surgical Management

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