Ventriculomegaly and postoperative lateral/third ventricular blood as predictors of cerebrospinal fluid diversion following posterior fossa tumor resection

2021 ◽  
pp. 1-11
Author(s):  
Christine Park ◽  
Beiyu Liu ◽  
Stephen C. Harward ◽  
Anru R. Zhang ◽  
Jared Gloria ◽  
...  
Keyword(s):  
Posterior Fossa ◽  
Tumor Resection ◽  
Residual Tumor ◽  
Posterior Fossa Tumor ◽  
Tumor Type ◽  
Cerebrospinal Fluid Diversion ◽  
Unit Increase ◽  
Csf Diversion ◽  
Postoperative Hydrocephalus ◽  
Occipital Horn

OBJECTIVE Postoperative hydrocephalus occurs in one-third of children after posterior fossa tumor resection. Although models to predict the need for CSF diversion after resection exist for preoperative variables, it is unknown which postoperative variables predict the need for CSF diversion. In this study, the authors sought to determine the clinical and radiographic predictors for CSF diversion in children following posterior fossa tumor resection. METHODS This was a retrospective cohort study involving patients ≤ 18 years of age who underwent resection of a primary posterior fossa tumor between 2000 and 2018. The primary outcome was the need for CSF diversion 6 months after surgery. Candidate predictors for CSF diversion including age, race, sex, frontal occipital horn ratio (FOHR), tumor type, tumor volume and location, transependymal edema, papilledema, presence of postoperative intraventricular blood, and residual tumor were evaluated using a best subset selection method with logistic regression. RESULTS Of the 63 included patients, 26 (41.3%) had CSF diversion at 6 months. Patients who required CSF diversion had a higher median FOHR (0.5 vs 0.4) and a higher percentage of postoperative intraventricular blood (30.8% vs 2.7%) compared with those who did not. A 0.1-unit increase in FOHR or intraventricular blood was associated with increased odds of CSF diversion (OR 2.9 [95% CI 1.3–7.8], p = 0.02 and OR 20.2 [95% CI 2.9–423.1], p = 0.01, respectively) with an overfitting-corrected concordance index of 0.68 (95% CI 0.56–0.80). CONCLUSIONS The preoperative FOHR and postoperative intraventricular blood were significant predictors of the need for permanent CSF diversion within 6 months after posterior fossa tumor resection in children.

Cerebellar mutism after posterior fossa tumor resection in children: a multicenter international retrospective study to determine possible modifiable factors

2019 ◽  
Vol 36 (6) ◽  
pp. 1159-1169 ◽  
Author(s):  
Bryan Renne ◽  
Julia Radic ◽  
Deepak Agrawal ◽  
Brittany Albrecht ◽  
Christopher M. Bonfield ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Posterior Fossa ◽  
Tumor Resection ◽  
Posterior Fossa Tumor ◽  
Cerebellar Mutism ◽  
Modifiable Factors

scholarly journals “Drowning Brain in a Pool of CSF” — A Rare Complication of Periencephalic Subdural Panhygroma following Removal of a Posterior Fossa Tumor

2017 ◽  
Vol 07 (03) ◽  
pp. 223-226
Author(s):  
Bikash Behera ◽  
Ram Deo ◽  
Sanjib Mishra ◽  
Jyotirmayee Biswal ◽  
Deepak Das
Keyword(s):  
Posterior Fossa ◽  
Case Reports ◽  
Rare Complication ◽  
Tumor Resection ◽  
Foramen Magnum ◽  
Posterior Fossa Tumor ◽  
Subdural Hygroma ◽  
Posterior Fossa Tumors ◽  
Suboccipital Craniotomy ◽  
Pediatric Age Group

AbstractPosterior fossa tumors are commonly encountered in pediatric age group patients. Most of these tumors present with features of hydrocephalus in the child. Conventionally, these cases are managed by suboccipital craniotomy with decompression of the tumor mass to establish the free flow of cerebrospinal fluid (CSF) across fourth ventricle and aqueduct of Sylvius. Following resection of posterior fossa tumor, appearance of subdural hygroma is a rare phenomenon.Though few cases of subdural hygroma are reported in literature following foramen magnum decompression in Chiari's malformation, their appearance following posterior fossa tumor resection is alien to medical literature and limited to only two case reports. Here the authors present a patient with periencephalic subdural panhygroma (PSP) following posterior fossa tumor resection who was successfully treated with a ventriculoperitoneal shunt (VPS) to accomplish a symptomatic and radiologic remission.

The pathophysiology of oral pharyngeal apraxia and mutism following posterior fossa tumor resection in children

1995 ◽  
Vol 83 (3) ◽  
pp. 467-475 ◽  
Author(s):  
Andrew T. Dailey ◽  
Guy M. McKhann ◽  
Mitchel S. Berger
Keyword(s):  
Posterior Fossa ◽  
Pediatric Patients ◽  
Tumor Resection ◽  
Posterior Fossa Tumor ◽  
Posterior Fossa Tumors ◽  
Lower Cranial Nerve ◽  
Content Type ◽  
Cranial Nerve Function ◽  
Pharyngeal Musculature ◽  
Fine Print

✓ Mutism following posterior fossa tumor resection in pediatric patients has been previously recognized, although its pathophysiology remains unclear. A review of the available literature reveals 33 individuals with this condition, with only a few adults documented in the population. All of these patients had large midline posterior fossa tumors. To better understand the incidence and anatomical substrate of this syndrome, the authors reviewed a 7-year series of 110 children who underwent a posterior fossa tumor resection. During that time, nine (8.2%) of the 110 children exhibited mutism postoperatively. They ranged from 2.5 to 20 years of age (mean 8.1 years) and became mute within 12 to 48 hours of surgery. The period of mutism lasted from 1.5 to 12 weeks after onset: all children had difficulty coordinating their oral pharyngeal musculature as manifested by postoperative drooling and inability to swallow. Further analysis of these cases revealed that all children had splitting of the entire inferior vermis at surgery, as confirmed on postoperative magnetic resonance studies. Lower cranial nerve function was intact in all nine patients. Current concepts of cerebellar physiology emphasize the importance of the cerebellum in learning and language. The syndrome described resembles a loss of learned activities, or an apraxia, of the oral and pharyngeal musculature. To avoid the apraxia, therefore, the inferior vermis must be preserved. For large midline tumors that extend to the aqueduct, a combined approach through the fourth ventricle and a midvermis split may be used to avoid injuring the inferior vermis.

Long-term cognitive deficits following posterior fossa tumor resection: A neuropsychological and functional neuroimaging follow-up study.

2009 ◽  
Vol 23 (6) ◽  
pp. 694-704 ◽  
Author(s):  
Hyo Jung De Smet ◽  
Hanne Baillieux ◽  
Peggy Wackenier ◽  
Mania De Praeter ◽  
Sebastiaan Engelborghs ◽  
...  
Keyword(s):  
Posterior Fossa ◽  
Cognitive Deficits ◽  
Functional Neuroimaging ◽  
Tumor Resection ◽  
Posterior Fossa Tumor ◽  
Follow Up Study

Prone Positioning for Posterior Fossa Tumor Resection

2013 ◽  
Author(s):  
Matthias W König ◽  
Mohamed A Mahmoud ◽  
John J McAuliffe
Keyword(s):  
Brain Tumors ◽  
Prone Position ◽  
Posterior Fossa ◽  
Tumor Resection ◽  
Posterior Fossa Tumor ◽  
Physiological Changes ◽  
Prone Positioning ◽  
Posterior Fossa Tumors ◽  
Common Malignancy

Brain tumors are the second most common malignancy in children. About one third occur in toddlers under the age of 3, and about two thirds are located in the posterior fossa. Resection of posterior fossa tumors is often a lengthy procedure that is commonly performed in the prone position. The prone position is associated with physiological changes and predisposes the patient to certain types of injuries.

Postoperative facial palsy after pediatric posterior fossa tumor resection

2021 ◽  
pp. 1-6
Author(s):  
Jason K. Chu ◽  
Peter A. Chiarelli ◽  
Nolan D. Rea ◽  
Norianne Pimentel ◽  
Benjamin E. Flyer ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Posterior Fossa ◽  
Facial Palsy ◽  
Tumor Resection ◽  
Significant Risk ◽  
Posterior Fossa Tumor ◽  
Facial Weakness ◽  
Multivariate Logistic Regression ◽  
Study Results

OBJECTIVE Facial palsy can be caused by masses within the posterior fossa and is a known risk of surgery for tumor resection. Although well documented in the adult literature, postoperative facial weakness after posterior fossa tumor resection in pediatric patients has not been well studied. The objective of this work was to determine the incidence of postoperative facial palsy after tumor surgery, and to investigate clinical and radiographic risk factors. METHODS A retrospective analysis was conducted at a single large pediatric hospital. Clinical, radiographic, and histological data were examined in children who were surgically treated for posterior fossa tumors between May 1, 1994, and June 1, 2011. The incidence of postoperative facial weakness was documented. A multivariate logistic regression model was used to analyze the predictive ability of clinicoradiological variables for facial weakness. RESULTS A total of 163 patients were included in this study. The average age at surgery was 7.4 ± 4.7 years, and tumor pathologies included astrocytoma (44%), medulloblastoma (36%), and ependymoma (20%). The lesions of 27 patients (17%) were considered high grade in nature. Thirteen patients (8%) exhibited preoperative symptoms of facial palsy. The overall incidence of postoperative facial palsy was 26% (43 patients), and the incidence of new postoperative facial palsy in patients without preoperative facial weakness was 20% (30 patients). The presence of a preoperative facial palsy had a large and significant effect in univariate analysis (OR 11.82, 95% CI 3.07–45.44, p < 0.01). Multivariate logistic regression identified recurrent operation (OR 4.45, 95% CI 1.49–13.30, p = 0.01) and other preoperative cranial nerve palsy (CNP; OR 3.01, 95% CI 1.24–7.29, p = 0.02) as significant risk factors for postoperative facial weakness. CONCLUSIONS Facial palsy is a risk during surgical resection of posterior fossa brain tumors in the pediatric population. The study results suggest that the incidence of new postoperative facial palsy can be as high as 20%. The presence of preoperative facial palsy, an operation for recurrent tumor, and the presence of other preoperative CNPs were found to be significant risk factors for postoperative facial weakness.

Posterior reversible encephalopathy syndrome during posterior fossa tumor resection in a child

2010 ◽  
Vol 6 (4) ◽  
pp. 377-380 ◽  
Author(s):  
Akash J. Patel ◽  
Benjamin D. Fox ◽  
Daniel H. Fulkerson ◽  
Sasidhar Yallampalli ◽  
Anna Illner ◽  
...  
Keyword(s):  
Posterior Fossa ◽  
Posterior Reversible Encephalopathy Syndrome ◽  
Severe Hypertension ◽  
Single Case ◽  
Tumor Resection ◽  
Posterior Fossa Tumor ◽  
Lower Cranial Nerve ◽  
Posterior Reversible Encephalopathy ◽  
Cranial Nerve Dysfunction ◽  
Reversible Encephalopathy

Posterior reversible encephalopathy syndrome (PRES) has been described in the setting of malignant hypertension, renal disease, eclampsia, and immunosuppression. In addition, a single case of intraoperative (posterior fossa craniotomy) PRES has been reported; however, this case occurred in an adult. The authors present a clinically and radiographically documented case of intraoperative PRES complicating the resection of a posterior fossa tumor in a 6-year-old child. During tumor resection, untoward force was used to circumferentially dissect the tumor, and excessive manipulation of the brainstem led to severe hypertension for a 10-minute period. An immediate postoperative MR image was obtained to rule out residual tumor, but instead the image showed findings consistent with PRES. Moreover, the patient's postoperative clinical findings were consistent with PRES. Aggressive postoperative management of blood pressure and the institution of anticonvulsant therapy were undertaken. The patient made a good recovery; however, he required a temporary tracheostomy and tube feedings for prolonged lower cranial nerve dysfunction. Posterior reversible encephalopathy syndrome can occur as a result of severe hypertension during surgery, even among young children. With prompt treatment, the patient in the featured case experienced significant clinical and radiographic recovery.

Graft dural closure is associated with a reduction in CSF leak and hydrocephalus in pediatric patients undergoing posterior fossa brain tumor resection

2020 ◽  
Vol 25 (3) ◽  
pp. 228-234
Author(s):  
Andrew T. Hale ◽  
Stephen R. Gannon ◽  
Shilin Zhao ◽  
Michael C. Dewan ◽  
Ritwik Bhatia ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Wound Infection ◽  
Posterior Fossa ◽  
Pediatric Patients ◽  
Tumor Resection ◽  
Csf Leak ◽  
Multivariate Logistic Regression ◽  
Dural Closure ◽  
Csf Diversion ◽  
Persistent Hydrocephalus

OBJECTIVEThe authors aimed to evaluate clinical, radiological, and surgical factors associated with posterior fossa tumor resection (PFTR)–related outcomes, including postoperative complications related to dural augmentation (CSF leak and wound infection), persistent hydrocephalus ultimately requiring permanent CSF diversion after PFTR, and 90-day readmission rate.METHODSPediatric patients (0–17 years old) undergoing PFTR between 2000 and 2016 at Monroe Carell Jr. Children’s Hospital of Vanderbilt University were retrospectively reviewed. Descriptive statistics included the Wilcoxon signed-rank test to compare means that were nonnormally distributed and the chi-square test for categorical variables. Variables that were nominally associated (p < 0.05) with each outcome by univariate analysis were included as covariates in multivariate linear regression models. Statistical significance was set a priori at p < 0.05.RESULTSThe cohort consisted of 186 patients with a median age at surgery of 6.62 years (range 3.37–11.78 years), 55% male, 83% Caucasian, and average length of follow-up of 3.87 ± 0.25 years. By multivariate logistic regression, the variables primary dural closure (PDC; odds ratio [OR] 8.33, 95% confidence interval [CI] 1.07–100, p = 0.04), pseudomeningocele (OR 7.43, 95% CI 2.23–23.76, p = 0.0007), and hydrocephalus ultimately requiring permanent CSF diversion within 90 days of PFTR (OR 9.25, 95% CI 2.74–31.2, p = 0.0003) were independently associated with CSF leak. PDC versus graft dural closure (GDC; 35% vs 7%, OR 5.88, 95% CI 2.94–50.0, p = 0.03) and hydrocephalus ultimately requiring permanent CSF diversion (OR 3.30, 95% CI 1.07–10.19, p = 0.0007) were associated with wound infection requiring surgical debridement. By multivariate logistic regression, GDC versus PDC (23% vs 37%, OR 0.13, 95% CI 0.02–0.87, p = 0.04) was associated with persistent hydrocephalus ultimately requiring permanent CSF diversion, whereas pre- or post-PFTR ventricular size, placement of peri- or intraoperative extraventricular drain (EVD), and radiation therapy were not. Furthermore, the addition of perioperative EVD placement and dural closure method to a previously validated predictive model of post-PFTR hydrocephalus improved its performance from area under the receiver operating characteristic curve of 0.69 to 0.74. Lastly, the authors found that autologous (vs synthetic) grafts may be protective against persistent hydrocephalus (p = 0.02), but not CSF leak, pseudomeningocele, or wound infection.CONCLUSIONSThese results suggest that GDC, independent of potential confounding factors, may be protective against CSF leak, wound infection, and hydrocephalus in patients undergoing PFTR. Additional studies are warranted to further evaluate clinical and surgical factors impacting PFTR-associated complications.

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