Management of non-communicable hydrocephalus due to posterior fossa tumors in children

DOI
  • Araki Kota
    Division of Neurosurgery, Tokyo Metropolitan Children's Medical Center
  • Kuroha Masae
    Division of Neurosurgery, Tokyo Metropolitan Children's Medical Center
  • Tsuda Kyoji
    Division of Neurosurgery, Tokyo Metropolitan Children's Medical Center
  • Ihara Satoshi
    Division of Neurosurgery, Tokyo Metropolitan Children's Medical Center

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  • 小児後頭蓋窩腫瘍に伴う非交通性水頭症の管理法の検討

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Abstract

<p>Background: Posterior fossa tumors are frequently associated with non-communicable hydrocephalus in children, but there are no specific guidelines for managing hydrocephalus in these patients.</p><p>Objectives: To investigate the implementation rate of postoperative permanent CSF diversion (VP shunt [VPS], endoscopic third ventriculostomy [ETV]) and its predictive factors.</p><p>Methods: We retrospectively analyzed 14 patients who underwent posterior fossa tumor resection at our hospital from April 2013 to March 2018. Baseline characteristics, clinical course, imaging data, and tumor pathology were analyzed. Primary outcome was permanent CSF diversion at 6 months after initial surgery.</p><p>Results: Management of Hydrocephalus at the time of the first surgery was 8 cases of external ventricular drainage [EVD], 5 cases of excision alone, and 1 case of ETV and EVD. Two patients (14.2%) required permanent CSF diversion 6 months after surgery. Comparison of the two groups by univariate analysis (with permanent CSF diversion vs. without), preoperative diagnosis (medulloblastoma) 100% vs 25% (p = 0.04), less than 2 years old 50.0% vs 0% (p = 0.01), dissemination 50.0% vs 0% (p = 0.01), excision rate (partial removal) 50.0% vs 0% (p = 0.01) were significantly different.</p><p>Discussion: In this study, only 14.2% of cases required persistent CSF diversion, which were similar to previous reports. There are some reports that recommend pre-resectional ETV, however, in most cases, many of them would be underwent unnecessary procedures for hydrocephalus that can be resolved only with excision with or without temporary EVD.</p><p>Conclusion: Permanent CSF diversion (VPS or ETV) was not essential at the time of initial surgery for posterior fossa tumors in children, and it could be managed by resection with or without EVD.</p>

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