Pediatric Posterior Fossa Tumors

Neurosurgery ◽  
1978 ◽  
Vol 3 (3) ◽  
pp. 339-343 ◽  
Author(s):  
Fred Epstein ◽  
Rajagopalan Murali
Keyword(s):  
Cerebrospinal Fluid ◽  
Posterior Fossa ◽  
Present Report ◽  
Increased Intracranial Pressure ◽  
Posterior Fossa Tumors ◽  
Pharmacological Management ◽  
Postoperative Course ◽  
Cerebrospinal Fluid Diversion ◽  
Upward Herniation ◽  
Definitive Surgery

Abstract Many neurosurgeons recommend a “preoperative” shunt for children with posterior fossa tumors. It has been reported that the definitive surgery is simplified and the postoperative course is more benign as a result of the cerebrospinal fluid diversion. The present report documents complications as a result of upward herniation and hemorrhage within the tumor after shunt placement. On the basis of this experience, we conclude that a shunt is potentially hazardous and should be restricted to that selected group of patients who are acutely ill from increased intracranial pressure that is refractory to temporizing pharmacological management.

Hydrocephalus in posterior fossa tumors in children. Are there factors that determine a need for permanent cerebrospinal fluid diversion?

2008 ◽  
Vol 24 (12) ◽  
pp. 1397-1403 ◽  
Author(s):  
Ricardo Santos de Oliveira ◽  
Carlos Eduardo Barros Jucá ◽  
Elvis Terci Valera ◽  
Hélio Rubens Machado
Keyword(s):  
Cerebrospinal Fluid ◽  
Posterior Fossa ◽  
Posterior Fossa Tumors ◽  
Cerebrospinal Fluid Diversion

Permanent Cerebrospinal Fluid Diversion in Adults With Posterior Fossa Tumors: Incidence and Predictors

Neurosurgery ◽  
2021 ◽  
Author(s):  
Hassan Saad ◽  
David P Bray ◽  
J Tanner McMahon ◽  
Brandon D Philbrick ◽  
Reem A Dawoud ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Posterior Fossa ◽  
Surgical Complications ◽  
External Ventricular Drain ◽  
Tertiary Care ◽  
Extent Of Resection ◽  
Subtotal Resection ◽  
Central Nervous System Tumor ◽  
Posterior Fossa Tumors ◽  
Csf Diversion

Abstract BACKGROUND Posterior fossa tumors (PFTs) can cause hydrocephalus. Hydrocephalus can persist despite resection of PFTs in a subset of patients requiring permanent cerebrospinal fluid (CSF) diversion. Characteristics of this patient subset are not well defined. OBJECTIVE To define preoperative and postoperative variables that predict the need for postoperative CSF diversion in adult patients with PFTs. METHODS We surveyed the CNS (Central Nervous System) Tumor Outcomes Registry at Emory (CTORE) for patients who underwent PFT resection at 3 tertiary-care centers between 2006 and 2019. Demographic, radiographic, perioperative, and dispositional data were analyzed using univariate and multivariate models. RESULTS We included 617 patients undergoing PFT resection for intra-axial (57%) or extra-axial (43%) lesions. Gross total resection was achieved in 62% of resections. Approximately 13% of patients required permanent CSF diversion/shunting. Only 31.5% of patients who required pre- or intraop external ventricular drain (EVD) placement needed permanent CSF diversion. On logistic regression, size, transependymal flow, use of perioperative EVD, postoperative intraventricular hemorrhage (IVH), and surgical complications were predictors of permanent CSF diversion. Preoperative tumor size was only independent predictor of postoperative shunting in patients with subtotal resection. In patients with intra-axial tumors, transependymal flow (P = .014), postoperative IVH (P = .001), surgical complications (P = .013), and extent of resection (P = .03) predicted need for shunting. In extra-axial tumors, surgical complications were the major predictor (P = .022). CONCLUSION Our study demonstrates that presence of preoperative hydrocephalus in patients with PFT does not necessarily entail the need for permanent CSF diversion. We report the major predictive factors for needing permanent CSF diversion.

External Ventricular Drainage in the Management of Posterior Fossa Tumors in Children and Adolescents

Neurosurgery ◽  
1982 ◽  
Vol 10 (1) ◽  
pp. 13-15 ◽  
Author(s):  
I. Papo ◽  
G. Caruselli ◽  
A. Luongo
Keyword(s):  
Children And Adolescents ◽  
Posterior Fossa ◽  
External Ventricular Drainage ◽  
Ventricular Drainage ◽  
Total Removal ◽  
Posterior Fossa Tumors ◽  
Postoperative Course ◽  
Csf Shunting ◽  
Before And After ◽  
Overall Mortality

Abstract External ventricular drainage (EVD) was used before and after posterior fossa operations in 62 children and adolescents. In all cases, the removal of the tumor (midline in 47 and lateral in 15) was attempted: total removal was achieved in 41. The overall mortality was 6.5% (4 patients). Only 25% of the survivors needed permanent cerebrospinal fluid (CSF) shunting. EVD seems, therefore, to be effective in controlling preoperative intracranial hypertension and in securing a smooth postoperative course. Preoperative CSF shunting seems to be necessary or advisable only in particular circum- stances.

Retrograde Third Ventriculocisternostomy From the Posterior Fossa

2012 ◽  
Vol 72 (1) ◽  
pp. ons9-ons14 ◽  
Author(s):  
Vijay Yanamadala ◽  
Brian P. Walcott ◽  
Brian V. Nahed ◽  
Fred G. Barker
Keyword(s):  
Cerebrospinal Fluid ◽  
Posterior Fossa ◽  
Third Ventricle ◽  
Third Ventriculostomy ◽  
High Likelihood ◽  
Single Patient ◽  
Cerebrospinal Fluid Diversion ◽  
Interpeduncular Cistern ◽  
Postoperative Hydrocephalus

Abstract Background: Postoperative hydrocephalus is common in patients after resection of a posterior fossa tumor, with as many as 25% of patients requiring permanent cerebrospinal fluid diversion in the form of ventricular shunting or ventriculocisternostomy in some series. Prophylactic ventriculocisternostomy has been described with success in this patient population to prevent postoperative hydrocephalus. Objective: To define the technique of microsurgical retrograde third ventriculostomy from the posterior fossa. Methods: The operative technique is described and a single patient with 4-year follow-up is reported. Results: We describe the case of a 32-year-old woman who presented with a large cerebellopontine angle epidermoid tumor. She underwent a simultaneous lesion resection and third ventriculocisternostomy by accessing the interpeduncular cistern via a suboccipital posterior fossa approach and then making an incision through the tuber cinereum to access the third ventricle under direct vision. Conclusion: Retrograde third ventriculostomy may be useful in the surgical treatment of patients already undergoing operations for large posterior fossa lesions who have a high likelihood of requiring permanent cerebrospinal fluid diversion and in whom exposure of the interpeduncular cistern is available.

Anesthesia for Posterior Fossa Mass

2018 ◽  
Author(s):  
Valerie L. Howell ◽  
Margaret M. Collins ◽  
Lauryn R. Rochlen
Keyword(s):  
Cerebrospinal Fluid ◽  
Posterior Fossa ◽  
Anesthetic Management ◽  
Perioperative Period ◽  
Craniovertebral Junction ◽  
Increased Intracranial Pressure ◽  
Hemodynamic Stability ◽  
Careful Planning ◽  
Neurophysiologic Monitoring ◽  
Intraoperative Neurophysiologic Monitoring

Lesions of the posterior fossa provide challenges for both anesthesiologists and surgeons due to this intracranial cavity’s rigid boundaries, minimal compliance, and vital neuronal contents. Common surgeries in the posterior fossa include excision of tumors, correction of congenital and acquired craniovertebral junction anomalies, and relief of pressure on the brainstem. Symptoms can present acutely and are most commonly due to compression of brain components, obstruction of cerebrospinal fluid, or increased intracranial pressure. Careful planning of the anesthetic is important to prevent exacerbation of preexisting symptoms or pathology, optimize the surgical resection, and aid in the quick diagnosis of postoperative complications. A variety of complications may occur in the perioperative period, many of which are unique to the posterior fossa or surgical approach. Anesthetic management focuses on prevention of common complications, maintenance of hemodynamic stability, facilitation of intraoperative neurophysiologic monitoring. and early postoperative neurologic evaluation through timely emergence.

Patients with autosomal-recessive osteopetrosis presenting with hydrocephalus and hindbrain posterior fossa crowding

2008 ◽  
Vol 1 (1) ◽  
pp. 103-106 ◽  
Author(s):  
Yahia Z. Al-Tamimi ◽  
Atul K. Tyagi ◽  
Paul D. Chumas ◽  
Darach W. Crimmins
Keyword(s):  
Cerebrospinal Fluid ◽  
Posterior Fossa ◽  
Autosomal Recessive ◽  
Neurological Complications ◽  
Heterogeneous Group ◽  
Cerebrospinal Fluid Diversion ◽  
Brainstem Compression ◽  
Bone Sclerosis ◽  
Autosomal Recessive Osteopetrosis

✓ Osteopetrosis is a heterogeneous group of disorders characterized by abnormal bone sclerosis. As a result, patients often require input regarding various neurological complications. Although autosomal-recessive osteopetrosis has been associated with hydrocephalus, it has not been linked to hindbrain abnormalities. The authors present 3 cases of auto-somal-recessive osteopetrosis in patients who presented with hydrocephalus. In each of these patients, cerebrospinal fluid diversion procedures were required and hindbrain compression developed. To date, only 1 patient has needed craniocervical decompression due to symptomatic brainstem compression.

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