Cerebrospinal Fluid Diversion Procedures in Children with Posterior Fossa Tumors : Ventriculoperitoneal Shunt Versus Endoscopic Third Ventriculostomy Versus External Ventricular Drainage

Treatment of hydrocephalus in posterior fossa tumors in children is still a matter of controversy and different centers have their own routines. In this regard, hospital records of all children with posterior fossa tumors treated in Children's Cancer Hospital Egypt, during the interval of 2008-2011 were reviewed. Patients' demographic and diagnostic data were analyzed and the frequencies of cerebrospinal fluid diversion procedures were determined. Exact test was employed to compare the frequency of postoperative complications in different groups. A total of 170 patients with age ranging from 3 months to 18 years and a male to female ratio of 1.5 comprised the study population. 161 cases had hydrocephalus at the time of diagnosis and 81 patients underwent preoperative shunting and 62 patients underwent endoscopic third ventriculostomy (ETV). Of the remaining 18 patients, 13 underwent external ventricular drainage at tumor operation session plus preoperative corticosteroid therapy. The rest of the patients got no primary treatment for hydrocephalus. Three of these 5 patients had postoperative shunting after tumor removal, but the other 2 remained shunt free. The rate of postoperative complications including cerebrospinal fluid leakage and septic meningitis were significantly lower in patients with preoperative shunting and ETV. The results of this study are in favor of those that approve the effect of preoperative shunting or ETV in decreasing postoperative complications. This is well established when the tumor size is big or when the diagnosis of posterior fossa tumor is made in later stages or when hydrocephalus is severe. It could be concluded that preoperative shunting or ETV can decrease the rate of postoperative complications. ETV also minimizes the risk of over drainage because it provides more physiological CSF drainage than the other procedures and avoids the complications of shunting procedures.

[1]  G. Reddy,et al.  Management of hydrocephalus in children with posterior fossa tumors , 2015, Surgical neurology international.

[2]  M. E. El Beltagy,et al.  Endoscopic third ventriculostomy before tumor surgery in children with posterior fossa tumors, CCHE experience , 2010, Child's Nervous System.

[3]  A. Simon,et al.  Epidemiology, Prevention and Management of Ventriculoperitoneal Shunt Infections in Children , 2009, Pediatric Neurosurgery.

[4]  R. Bhatia,et al.  The Management of Hydrocephalus in Children with Posterior Fossa Tumours: The Role of Pre-Resectional Endoscopic Third Ventriculostomy , 2009, Pediatric Neurosurgery.

[5]  H. Machado,et al.  Hydrocephalus in posterior fossa tumors in children. Are there factors that determine a need for permanent cerebrospinal fluid diversion? , 2008, Child's Nervous System.

[6]  R. Grundy,et al.  Presentation of childhood CNS tumours: a systematic review and meta-analysis. , 2007, The Lancet. Oncology.

[7]  E. Helseth,et al.  Management of Hydrocephalus in Children with Posterior Fossa Tumors: Role of Tumor Surgery , 2007, Pediatric Neurosurgery.

[8]  S. M. Abdollahzadeh-Hosseini,et al.  MANAGEMENT OF HYDROCEPHALUS IN POSTERIOR CRANIAL FOSSA TUMORS , 2006 .

[9]  H. Lanfermann,et al.  Pilocytic astrocytomas of the posterior fossa a follow-up study in 33 patients , 2005, Acta Neurochirurgica.

[10]  N. Greco,et al.  Shunt Related Abdominal Metastases in an Infant with Medulloblastoma: Long Term Remission by Systemic Chemotherapy and Surgery , 2001, Journal of Neuro-Oncology.

[11]  Khaleeq-uz-Zaman,et al.  Role of cerebrospinal fluid diversion in posterior fossa tumor surgery. , 2003, Journal of the College of Physicians and Surgeons--Pakistan : JCPSP.

[12]  L. Bognár,et al.  Analysis of CSF shunting procedure requirement in children with posterior fossa tumors , 2003, Child's Nervous System.

[13]  W. Maixner,et al.  Management of hydrocephalus in pediatric patients with posterior fossa tumors: the role of endoscopic third ventriculostomy. , 1999, Journal of neurosurgery.

[14]  E. Ventureyra,et al.  Medulloblastoma in children – the Ottawa experience , 2000, Child's Nervous System.

[15]  J. Shohet,et al.  Neurotologic follow-up after radiation of posterior fossa tumors. , 2000, The American journal of otology.

[16]  Giuseppe Cinalli,et al.  Alternatives to shunting , 1999, Child's Nervous System.

[17]  A. Jamjoom,et al.  Intraventricular and leptomeningeal dissemination of a pilocytic cerebellar astrocytoma in a child with a ventriculoperitoneal shunt: case report. , 1998, British journal of neurosurgery.

[18]  K. Phipps,et al.  Ventriculo-peritoneal shunt requirement in children with posterior fossa tumours: an 11-year audit. , 1996, British journal of neurosurgery.

[19]  T. Shiminski‐Maher,et al.  Hydrocephalus and shunts in children with brain tumors. , 1995, Journal of Pediatric Oncology Nursing.

[20]  D. Culley,et al.  An analysis of factors determining the need for ventriculoperitoneal shunts after posterior fossa tumor surgery in children. , 1994, Neurosurgery.

[21]  A. Goel.  Whither preoperative shunts for posterior fossa tumours? , 1993, British journal of neurosurgery.

[22]  W. Boratyński,et al.  [Indications for the shunt treatment of children with cerebellar astrocytoma]. , 1992, Neurologia i Neurochirurgia Polska.

[23]  I. Spiridonov,et al.  [Shunt surgery in occlusive processes in the posterior cranial fossa of children]. , 1987, Voprosy neirokhirurgii imeni N N Burdenko.

[24]  T. Tomita,et al.  Hydrocephalus and infratentorial tumors. Incidence, clinical picture, and treatment. , 1981, Journal of neurosurgery.

[25]  R. G. de Sola,et al.  Intratumoral hemorrhage in posterior fossa tumors after ventricular drainage. Report of two cases. , 1981, Journal of neurosurgery.

[26]  C. Wilson.  Diagnosis and surgical treatment of childhood brain tumors , 1975, Cancer.

[27]  H. Cushing.  EXPERIENCES WITH THE CEREBELLAR ASTROCYTOMA. A CLINICAL REVIEW OF SEVENTY-SIX CASES , 1931 .