Infratentorial complications following preresection CSF diversion in children with posterior fossa tumors

2015 ◽  
Vol 15 (1) ◽  
pp. 4-11 ◽  
Author(s):  
Mohamed Ali El-Gaidi ◽  
Ashraf Hesham Abou El-Nasr ◽  
Ehab Mohamed Eissa
Keyword(s):  
Posterior Fossa ◽  
Medical Records ◽  
University Hospital ◽  
Third Ventriculostomy ◽  
Posterior Fossa Tumors ◽  
Vp Shunt ◽  
Computed Tomography Scans ◽  
Csf Diversion ◽  
Tentorial Incisura ◽  
Severe Hydrocephalus

OBJECT This report presents the incidence, causes, and morbidity and mortality of infratentorial complications following CSF diversion before resection in children with posterior fossa tumors. METHODS The medical records of 437 children admitted to Abo El-Reesh Pediatric University Hospital with a diagnosis of posterior fossa tumor between 2005 and 2012 were retrospectively reviewed. Seven children developed neurological deterioration following CSF diversion due to infratentorial complications. Computed tomography scans revealed intratumoral hemorrhage (ITH) in 5 cases, while upward transtentorial herniation (UTH), as evidenced by obliteration of the quadrigeminal and ambient cisterns, was diagnosed in 2 cases. RESULTS Hydrocephalus was noted in 381 patients, and 301 patients underwent CSF diversion before resection. A ventriculoperitoneal (VP) shunt was used in 214 patients, and 6 children (2.8% of shunted cases) deteriorated neurologically (4 due to ITH and 2 due to UTH). Endoscopic third ventriculostomy (ETV) was performed in 87 patients, 1 of whom developed ITH (1.1% of the patients undergoing ETV). Six patients deteriorated within 8 hours (85.7%), whereas 1 patient, the only survivor, deteriorated after 24 hours. The incidence of infratentorial complications between VP shunts and ETVs was not found to be significantly different (p = 0.659). There was a higher risk of such complications in large posterior fossa tumors (diameter ≥ 4 cm) extending close to the tentorial incisura, especially in patients with severe hydrocephalus and significant peritumoral edema. CONCLUSIONS Infratentorial complications (ITH and UTH) in children with posterior fossa tumors are not uncommon (2.3%) after preresection CSF diversion (VP shunt or ETV) and are associated with a very poor prognosis in most cases, even with surgical intervention.

Ventriculoperitoneal Shunt versus Endoscopic Third Ventriculostomy in the treatment of Obstructive Hydrocephalus in Pediatric Midline Posterior Fossa tumors

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Mohammed Tarek ◽  
Hamdy Ibrahim ◽  
H Jalalod'din ◽  
SR Tawadros
Keyword(s):  
Posterior Fossa ◽  
Ventriculoperitoneal Shunt ◽  
Endoscopic Third Ventriculostomy ◽  
Obstructive Hydrocephalus ◽  
Clinical Findings ◽  
Third Ventriculostomy ◽  
Posterior Fossa Tumors ◽  
Shunt Insertion ◽  
Vp Shunt ◽  
Csf Diversion

Abstract Background Treatment of secondary hydrocephalus due to posterior fossa tumors in these children is still a matter of controversy, although preoperative ventriculo-peritoneal shunt (VP shunt) insertion before tumor excision is widely accepted among neurosurgeons but many attempts are rising to minimize permanent VP shunt insertion and associated complications and introducing third endoscopic ventriculostomy (ETV) as one of the options of 2ry hydrocephalus. Objectives Comparing the post-operative clinical success with resolution of the manifestations and post-operative complications between endoscopic third ventriculostomy and ventriculoperitoneal shunt as different modes of CSF diversion in children with 2ry hydrocephalus due to midline posterior fossa tumors. Methods The following electronic databases were searched from June 2009 to june2019: PubMed, Google scholar search engine. Cochrane database of systematic reviews, EMBASE and science Direct, using the keywords ―hydrocephalus; posterior fossa tumors; pediatrics; ventriculoperitoneal shunt; endoscopic third ventriculostomy‖. Studies were eligible if they contain the target keywords in title or abstract, addressing the Pediatric age group with 2ry hydrocephalus due to de novo posterior fossa tumor manifested by signs of increase the intra cranial tension including persistent headache and vomiting, blurred vision, 6th nerve palsy, papilledema in fundus examination, acute DCL and 2ry hydrocephalus confirmed by brain imaging. Exclusion criteria included studies including age group below 1yr or above 18 yr, or patients with recurrent post fossa tumors and operated before or patients presented by failed previously attempt of CSF diversion. Results: A total of 1255 citations were screened for eligibility,6 studies were included in our systematic review discussing, comparing and evaluating the durability of ETV versus VP shunt in treatment the 2ry hydrocephalusdue to pediatric posterior fossa tumor.. Overall study population reached 474 patients. the overall clinical findings at presentation and postoperative outcomes regarding the clinical findings improvement, radiological improvement and postoperative complications between ETV and VP shunt are compared and showing that ETV should be considered as an alternative procedure to VP shunt in controlling severe hydrocephalus related to posterior fossa tumors to relieve symptoms quickly during the preoperative period when patients should wait for their definite tumor excision. Conclusion The shorter duration of surgery, the lower incidence of morbidity, the absence of mortality, the lower incidence of procedure failure of endoscopic third ventriculostomy as compared to ventriculoperitoneal shunt, and the significant advantage of not becoming shunt dependent make endoscopic third ventriculostomy to be recommended as the first choice in the treatment of pediatric patients with marked obstructive hydrocephalus due to posterior fossa tumors. It is a preliminary, simple, safe, effective, physiological, minimally invasive procedure for the relief of elevated intracranial pressure before direct tumor removal.

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.

Endoscopic Third Ventriculostomy in the Treatment of Hydrocephalus Associated with Posterior Fossa Tumors in Children

Neurosurgery ◽  
1999 ◽  
Vol 45 (3) ◽  
pp. 734-735
Author(s):  
F. E. Roux ◽  
G. Cinalli ◽  
C. Sainte-Rose ◽  
P. Chumas ◽  
M. Zerah ◽  
...  
Keyword(s):  
Posterior Fossa ◽  
Endoscopic Third Ventriculostomy ◽  
Third Ventriculostomy ◽  
Posterior Fossa Tumors

Endoscopic Third Ventriculostomy before Posterior Fossa Tumor Surgery in Adult Patients

2017 ◽  
Vol 79 (02) ◽  
pp. 123-129 ◽  
Author(s):  
Ahmed El Damaty ◽  
Jotham Manwaring ◽  
Ehab El Refaee ◽  
Steffen Fleck ◽  
Michael Fritsch ◽  
...  
Keyword(s):  
Posterior Fossa ◽  
Obstructive Hydrocephalus ◽  
External Ventricular Drain ◽  
Clinical Signs ◽  
Adult Patients ◽  
Posterior Fossa Tumor ◽  
Third Ventriculostomy ◽  
Tumor Surgery ◽  
Posterior Fossa Tumors ◽  
Asymptomatic Patients

Objective Obstructive hydrocephalus in patients with posterior fossa tumors is frequently seen. Treatment options include immediate tumor removal or prior cerebrospinal fluid (CSF) diversion procedures. The necessity and feasibility of an ETV in these situations has not yet been proven in adult patients. Methods We retrospectively reviewed our prospectively maintained database for ETVs before surgery of posterior fossa tumors in adults. The primary focus of data analyses was the question of whether the ETV was suitable to treat the acute situation of hydrocephalus without an increased rate of complications due to the special anatomical situation with a posterior fossa tumor. We also analyzed whether any further CSF diverting procedures were necessary. Results A total of 40 adult patients who underwent an ETV before posterior fossa tumor surgery were analyzed. Overall, 33 patients (82.5%) had clinical signs of hydrocephalus, and all of them improved in their clinical course after ETV. Seven patients (17.5%) did not demonstrate clinical signs of hydrocephalus, but ETV was performed with prophylactic or palliative intent in six patients and one patient, respectively. No complications were observed due to ETV itself. No permanent shunting procedure was necessary in a mean follow-up of 76.5 months. Early additional CSF diverting procedures (redo ETV, external ventricular drain) were performed in five patients (12.5%). Conclusion The present series confirms the feasibility and safety of ETV before posterior fossa tumor surgery in adult patients. If patients had symptomatic hydrocephalus before tumor surgery, an ETV can be performed, followed by early elective tumor surgery. A prophylactic ETV in asymptomatic patients is not advised. Early elective tumor surgery should be performed in these patients.

Successful management of symptomatic hydrocephalus using a temporary external ventricular drain with or without endoscopic third ventriculostomy in pediatric patients with germinoma

2021 ◽  
pp. 1-6
Author(s):  
Rebecca Ronsley ◽  
Eric Bouffet ◽  
Peter Dirks ◽  
James Drake ◽  
Abhaya Kulkarni ◽  
...  
Keyword(s):  
Pediatric Patients ◽  
Endoscopic Third Ventriculostomy ◽  
External Ventricular Drain ◽  
Retrospective Chart Review ◽  
Progression Free Survival ◽  
Tumor Location ◽  
Third Ventriculostomy ◽  
Timely Initiation ◽  
Vp Shunt ◽  
Csf Diversion

OBJECTIVE The objective of this study was to describe the management of hydrocephalus in a cohort of pediatric patients with germinoma. METHODS The authors conducted a retrospective chart review of patients with germinoma and symptomatic hydrocephalus treated at the Hospital for Sick Children between 2002 and 2020. Descriptive data included tumor location, CSF diversion procedure (external ventricular drain [EVD], endoscopic third ventriculostomy [ETV], ventriculoperitoneal [VP] shunt) and outcomes. The frontooccipital horn ratio (FOR) method was used to determine the presence of ventriculomegaly. RESULTS Of 39 patients with germinoma, 22 (73% male) had symptomatic hydrocephalus at diagnosis (11 pineal, 4 suprasellar, and 7 bifocal). Management of hydrocephalus included EVD (n = 5, 22.7%), ETV (n = 5, 22.7%), and combination ETV and EVD (n = 7, 31.8%), whereas 5 patients (22.7%) did not undergo surgical intervention. The median FOR at diagnosis was 0.42 (range 0.38–0.58), which correlated with moderate to severe ventriculomegaly. Carboplatin and etoposide–based chemotherapy induced fast tumor shrinkage, avoiding CSF diversion (n = 5) and resolving hydrocephalus with a transient EVD (n = 5). The median duration until EVD removal was 7 days (range 2–10 days). Two of 12 patients with EVD ultimately required a VP shunt. Kaplan-Meier overall survival was 100% and progression-free survival was 96.4% at a median follow-up of 10.4 years. CONCLUSIONS Timely initiation of chemotherapy is imperative to rapidly reduce tumor bulk in children with germinoma and limits the need for VP shunt insertions. In children in whom CSF diversion is required, hydrocephalus may be successfully managed with a temporary EVD ± ETV.

Endoscopic third ventriculostomy prior to resection of posterior fossa tumors in children

2019 ◽  
Vol 35 (5) ◽  
pp. 789-794 ◽  
Author(s):  
Fabio Frisoli ◽  
Michael Kakareka ◽  
Kristina A. Cole ◽  
Angela J Waanders ◽  
Phillip B. Storm ◽  
...  
Keyword(s):  
Posterior Fossa ◽  
Endoscopic Third Ventriculostomy ◽  
Third Ventriculostomy ◽  
Posterior Fossa Tumors

Choroid plexus coagulation in infants with extreme hydrocephalus or hydranencephaly

2014 ◽  
Vol 14 (1) ◽  
pp. 55-57 ◽  
Author(s):  
Sylvia Shitsama ◽  
Nunthasiri Wittayanakorn ◽  
Humphrey Okechi ◽  
A. Leland Albright
Keyword(s):  
Choroid Plexus ◽  
Medical Records ◽  
Congenital Hydrocephalus ◽  
Shunt Insertion ◽  
Radiographic Images ◽  
Vp Shunt ◽  
Shunt Placement ◽  
Csf Leakage ◽  
Lost To Follow Up ◽  
Severe Hydrocephalus

Object Severe hydrocephalus and hydranencephaly are common congenital conditions in Kenya. In patients with these conditions, ventriculoperitoneal (VP) shunts are associated with appreciable complications and endoscopic third ventriculostomies (ETVs) have limited success. Endoscopic choroid plexus coagulation (CPC) to diminish CSF production is a potential treatment option. The purpose of this study was to evaluate the effect of CPC without ETV in infants with severe hydrocephalus or hydranencephaly. Methods Medical records of infants with severe congenital hydrocephalus or hydranencephaly who underwent CPC in Kijabe Hospital from November 2010 to April 2013 were reviewed retrospectively. Thirty-three patients with complete medical records and preoperative radiographic images were identified. After CPC, the infants were followed in the Kijabe Hospital outpatient department, in mobile clinics, or by telephone. Success of the CPC was defined as resolution of preoperative symptoms, stabilization of head size, and avoidance of VP shunt placement. Results Patients were followed from 30 to 608 days (median of 120 days). Three patients were lost to follow-up. Of the 30 evaluable patients, CPC was considered to be successful in 13 (43.3%), including 8 of 20 patients with severe hydrocephalus and 5 of 10 with hydranencephaly. Failure of CPC was evident from increased head circumference in 14 (82%) of 17 patients and from CSF leakage in 3. Of the 17 failures, 13 occurred within 3 months of surgery. Six patients died: 3 whose CPC procedures were failures, 2 whose CPC was successful, and 1 postoperatively. Of the 17 in whom CPC failed, 10 subsequently underwent VP shunt insertion. Conclusions CPC stabilizes macrocephaly in approximately 40% of infants with severe congenital hydrocephalus and hydranencephaly and can be considered as an alternative to VP shunt placement.

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

2001 ◽  
Vol 95 (5) ◽  
pp. 791-797 ◽  
Author(s):  
Christian Sainte-Rose ◽  
Giuseppe Cinalli ◽  
Franck E. Roux ◽  
Wirginia Maixner ◽  
Paul D. Chumas ◽  
...  
Keyword(s):  
Posterior Fossa ◽  
Endoscopic Third Ventriculostomy ◽  
Tumor Resection ◽  
Third Ventriculostomy ◽  
Posterior Fossa Surgery ◽  
Posterior Fossa Tumors ◽  
Content Type ◽  
Group A ◽  
Group B ◽  
Fine Print

Object. The authors undertook a study to evaluate the effectiveness of endoscopic third ventriculostomy in the management of hydrocephalus before and after surgical intervention for posterior fossa tumors in children. Methods. Between October 1, 1993, and December 31, 1997, a total of 206 consecutive children with posterior fossa tumors underwent surgery at Hôpital Necker—Enfants Malades in Paris. Excluded were 10 patients in whom shunts had been placed at the referring hospital. The medical records and neuroimaging studies of the remaining 196 patients were reviewed and categorized into three groups: Group A, 67 patients with hydrocephalus present on admission in whom endoscopic third ventriculostomy was performed prior to tumor removal; Group B, 82 patients with hydrocephalus who did not undergo preliminary third ventriculostomy but instead received conventional treatment; and Group C, 47 patients in whom no ventricular dilation was present on admission. There were no significant differences between patients in Group A or B with respect to the following variables: age at presentation, evidence of metastatic disease, extent of tumor resection, or follow-up duration. In patients in Group A, however, more severe hydrocephalus was demonstrated (p < 0.01); the patients in Group C were in this respect different from those in the other two groups. Ultimately, there were only four patients (6%) in Group A compared with 22 patients (26.8%) in Group B (p = 0.001) in whom progressive hydrocephalus required treatment following removal of the posterior fossa tumor. Sixteen patients (20%) in Group B underwent insertion of a ventriculoperitoneal shunt, which is similar to the incidence reported in the literature and significantly different from that demonstrated in Group A (p < 0.016). The other six patients (7.3%) were treated by endoscopic third ventriculostomy after tumor resection. In Group C, two patients (4.3%) with postoperative hydrocephalus underwent endoscopic third ventriculostomy. In three patients who required placement of CSF shunts several episodes of shunt malfunction occurred that were ultimately managed by endoscopic third ventriculostomy and definitive removal of the shunt. There were no deaths; however, there were four cases of transient morbidity associated with third ventriculostomy. Conclusions. 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.

Sign in / Sign up

Export Citation Format

Share Document