The role of ventriculoperitoneal shunting in patients with supratentorial glioma

Fuente, Macarena I. de la; DeAngelis, Lisa M.

doi:10.1002/acn3.17

Cited by 14 publications

(4 citation statements)

References 13 publications

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“…De la Fuente analysed 62 patients with supratentorial glioma, of which 41 had glioblastoma. Among these patients, 27% had complications related to ventriculoperitoneal shunts [ 12 ]. Further, a more recent study reported that shunt complications required surgical revision in 4 of 12 (33%) high-grade glioma patients with ventriculo-/cystoperitoneal shunts [ 34 ].…”

Section: Discussionmentioning

confidence: 99%

Challenges in cerebrospinal fluid shunting in patients with glioblastoma

Hong

Polemikos

Heissler

et al. 2018

Fluids Barriers CNS

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BackgroundCerebrospinal fluid (CSF) circulation disturbances may occur during the course of disease in patients with glioblastoma. Ventriculoperitoneal shunting has generally been recommended to improve symptoms in glioblastoma patients. Shunt implantation for patients with glioblastoma, however, presents as a complex situation and produces different problems to shunting in other contexts. Information on complications of shunting glioma patients has rarely been the subject of investigation. In this retrospective study, we analysed restropectively the course and outcome of glioblastoma-related CSF circulation disturbances after shunt management in a consecutive series of patients within a period of over a decade.MethodsThirty of 723 patients with histopathologically-confirmed glioblastoma diagnosed from 2002 to 2016 at the Department of Neurosurgery, Hannover Medical School, underwent shunting for CSF circulation disorders. Treatment history of glioblastoma and all procedures associated with shunt implementation were analyzed. Data on follow-up, time to progression and survival rates were obtained by review of hospital charts and supplemented by phone interviews with the patients, their relations or the primary physicians.ResultsMean age at the time of diagnosis of glioblastoma was 43 years. Five types of CSF circulation disturbances were identified: obstructive hydrocephalus (n = 9), communicating hydrocephalus (n = 15), external hydrocephalus (n = 3), trapped lateral ventricle (n = 1), and expanding fluid collection in the resection cavity (n = 2). All patients showed clinical deterioration. Procedures for CSF diversion were ventriculoperitoneal shunt (n = 21), subduroperitoneal shunt (n = 3), and cystoperitoneal shunt (n = 2). In patients with lower Karnofsky Performance Score (KPS) (< 60), there was a significant improvement of median KPS after shunt implantation (p = 0.019). Shunt revision was necessary in 9 patients (single revision, n = 6; multiple revisions, n = 3) due to catheter obstruction, catheter dislocation, valve defect, and infection. Twenty-eight patients died due to disease progression during a median follow-up time of 88 months. The median overall survival time after diagnosis of glioblastoma was 10.18 months.ConclusionsCSF shunting in glioblastoma patients encounters more challenge and is associated with increased risk of complications, but these can be usually managed by revision surgeries. CSF shunting improves neurological function temporarily, enhances quality of life in most patients although it is not known if survival rate is improved.

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Section: Discussionmentioning

confidence: 99%

Challenges in cerebrospinal fluid shunting in patients with glioblastoma

Hong

Polemikos

Heissler

et al. 2018

Fluids Barriers CNS

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“…Placing a VPS in patients with LMD may be followed by radiation to symptomatic areas, treatment with systemic BBB‐penetrating chemotherapy (e.g. methotrexate and cytarabine) and, potentially, intrathecal chemotherapy in patients without bulky leptomeningeal disease and significant hydrocephalus (Clarke, ; de la Fuente & DeAngelis, ). Intrathecal chemotherapy may not be appropriate in a patient with overt hydrocephalus because of a risk for necrotizing leucoencephalopathy (Omuro et al , ; Lin & Avila, ).…”

Section: Elevated Intracranial Pressurementioning

confidence: 99%

Central nervous system emergencies in haematological malignancies

Fuente

Alderuccio

2019

Br J Haematol

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Summary Neurological emergencies are frequently catastrophic events in the course of haematological malignancies (HM) that, if not promptly recognized and treated, may lead to lethal outcomes or chronic sequelae. They may occur at any time during the disease course, but are more frequently observed following relapse. Practice guidelines are lacking in the management of most central nervous system (CNS) complications in HM. Herein we review the pathophysiology, presentation and treatment of elevated intracranial pressure, spinal cord compression, status epilepticus, neurovascular complications, CNS infection, leucostasis and hyperviscosity. Further, we discuss the expanding spectrum of neurological complications of old and novel treatments in HM.

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“…When the process is sufficiently indolent, the ventricles may enlarge without increasing the opening pressure. 34 This latter group develops symptoms of normal pressure hydrocephalus, that is, apraxic gait, incontinence, and progressive confusion. 1 Other signs and symptoms of leptomeningeal carcinomatosis that co-occur with hydrocephalus, which help to make the diagnosis, include CN palsies, radiculopathy, nuchal rigidity, and cortical deficits.…”

Section: Hydrocephalusmentioning

confidence: 99%

“…While an improvement in neurologic symptoms following a high-volume CSF drainage suggests that the patient will benefit from a ventriculoperitoneal shunt, patients with large ventricles, with the right clinical phenotype, may benefit from a ventriculoperitoneal shunt in spite of a negative tap test. 34 Placing a ventriculoperitoneal shunt in patients with leptomeningeal disease may be followed by radiation to symptomatic areas, treatment with systemic chemotherapy with good blood-brain barrier penetration, and potentially intrathecal chemotherapy in patients who do not have bulky leptomeningeal disease and without significant hydrocephalus. 35 Intrathecal chemotherapy may not be appropriate in a patient with overt hydrocephalus because it is a risk factor for the development of a necrotizing leukoencephalopathy.…”

Section: Hydrocephalusmentioning

confidence: 99%

Neurologic Emergencies in the Patients With Cancer

Lin

Avila

2016

J Intensive Care Med

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Neurologic complications of cancer are common and are frequently life-threatening events. Certain neurologic emergencies occur more frequently in the cancer population, specifically elevated intracranial pressure, epidural cord compression, status epilepticus, ischemic and hemorrhagic stroke, central nervous system infection, and treatment associated neurologic dysfunction. These emergencies require early diagnosis and prompt treatment to ensure the best possible outcome and are best managed in the intensive care unit. This article reviews the presentation, pathophysiology, and management of the most common causes of acute neurologic decompensation in the patient with cancer.

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The role of ventriculoperitoneal shunting in patients with supratentorial glioma

Cited by 14 publications

References 13 publications

Challenges in cerebrospinal fluid shunting in patients with glioblastoma

Challenges in cerebrospinal fluid shunting in patients with glioblastoma

Central nervous system emergencies in haematological malignancies

Neurologic Emergencies in the Patients With Cancer

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