Publication year: 2012
Source: World Neurosurgery, Available online 10 February 2012
Federico Di Rocco, Carlos Eduardo Jucá, Michel Zerah, Christian Sainte-Rose
BackgroundThe management of hydrocephalus associated to a posterior fossa tumor is debated. Some authors emphasize the advantages of an immediate tumor removal which may normalize the cerebrospinal fluid (CSF) dynamics. However, in the clinical practice the mere excision of the lesion has been demonstrated to be accompanied by a persisting hydrocephalus in about one third of the cases.Preoperative endoscopic third ventriculostomy (ETV) offers several advantages. It may control the intracranial pressure (ICP), avoid the necessity of an emergency procedure, allow to schedule the operation for tumor removal appropriately, and eliminate the risks related to the presence of an external drainage. The procedure also reduces the incidence of postoperative hydrocephalus. A final advantage, more difficult to weight, but obvious to the neurosurgeon, is the possibility to remove the lesion with a relaxed brain and normal ICP.In the post-operative phase, ETV can be used in case of persisting hydrocephalus, both in patients who underwent only the excision of the tumor or also in subjects whose preoperative ETV failed as a consequence of intraventricular bleeding with secondary closure of the stoma (redoETV). The main advantage of postoperative ETV is that the procedure is carried out only in case of persisting hydrocephalus; its use is consequently more selective than preoperative ETV. The disadvantage consists in the common use of an external CSF drainage in the first post-operative days which is necessary to control the pressure and for ruling out those cases that reach a spontaneous cure of the hydrocephalus.MethodsThe authors review the criteria for patient selection and the results of ETV performed in case of hydrocephalus secondary to a posterior fossa tumor.Results and conclusionspreoperative ETV constitutes an effective procedure for controlling the hydrocephalus associated to posterior fossa tumors. It might lower the rate of persistent postoperative hydrocephalus and result in a short hospital stay. Low rates of patients requiring an extrathecal – CSF shunt device are also reported by authors who utilize ETV postoperatively. As, however, the assessment of the persistent hydrocephalus in these children is based on prolonged ICP monitoring through an external CSF drainage, their results are weighted by a major risk of infective complications and longer duration hospital stay.
Source: World Neurosurgery, Available online 10 February 2012
Federico Di Rocco, Carlos Eduardo Jucá, Michel Zerah, Christian Sainte-Rose
BackgroundThe management of hydrocephalus associated to a posterior fossa tumor is debated. Some authors emphasize the advantages of an immediate tumor removal which may normalize the cerebrospinal fluid (CSF) dynamics. However, in the clinical practice the mere excision of the lesion has been demonstrated to be accompanied by a persisting hydrocephalus in about one third of the cases.Preoperative endoscopic third ventriculostomy (ETV) offers several advantages. It may control the intracranial pressure (ICP), avoid the necessity of an emergency procedure, allow to schedule the operation for tumor removal appropriately, and eliminate the risks related to the presence of an external drainage. The procedure also reduces the incidence of postoperative hydrocephalus. A final advantage, more difficult to weight, but obvious to the neurosurgeon, is the possibility to remove the lesion with a relaxed brain and normal ICP.In the post-operative phase, ETV can be used in case of persisting hydrocephalus, both in patients who underwent only the excision of the tumor or also in subjects whose preoperative ETV failed as a consequence of intraventricular bleeding with secondary closure of the stoma (redoETV). The main advantage of postoperative ETV is that the procedure is carried out only in case of persisting hydrocephalus; its use is consequently more selective than preoperative ETV. The disadvantage consists in the common use of an external CSF drainage in the first post-operative days which is necessary to control the pressure and for ruling out those cases that reach a spontaneous cure of the hydrocephalus.MethodsThe authors review the criteria for patient selection and the results of ETV performed in case of hydrocephalus secondary to a posterior fossa tumor.Results and conclusionspreoperative ETV constitutes an effective procedure for controlling the hydrocephalus associated to posterior fossa tumors. It might lower the rate of persistent postoperative hydrocephalus and result in a short hospital stay. Low rates of patients requiring an extrathecal – CSF shunt device are also reported by authors who utilize ETV postoperatively. As, however, the assessment of the persistent hydrocephalus in these children is based on prolonged ICP monitoring through an external CSF drainage, their results are weighted by a major risk of infective complications and longer duration hospital stay.
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