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External ventricular drainage in the management of pediatric patients with posterior fossa tumors and hydrocephalus: a retrospective cohort study

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Abstract

Purpose

To determine whether intraoperative adjunctive EVD placement in patients with a posterior fossa tumor (PFT) led to improved surgical, radiographic, and clinical outcomes compared to those who did not receive an EVD.

Methods

Patients were grouped as those who underwent routine intraoperative adjunctive EVD insertion and those who did not at time of PFT resection. Patients who pre-operatively required a clinically indicated EVD insertion were excluded. Comparative analyses between both groups were conducted to evaluate clinical, radiological, and pathological outcomes. Odds ratios (ORs) with corresponding 95% confidence intervals (CIs) were computed for post-operative outcomes.

Results

Fifty-five selected patients were included, 15 who had an EVD placed at the time of PFT resection surgery, and 40 who did not. Children without an EVD did not experience a higher rate of complications or poorer post-operative outcomes compared to those with an EVD placed during resection surgery. There was no significant difference in the degree of gross total resection (p = 0.129), post-operative CSF leak (p = 1.000), and post-operative hemorrhage (p = 0.554) between those with an EVD and those without. The frequency of new cranial nerve deficits post-operatively was higher in those with an EVD (40%) compared to those without (3%, p = 0.001). There was a trend towards more frequently observed post-operative hydrocephalus in the EVD group (p = 0.057).

Conclusion

The routine use of EVD as an intraoperative adjunct in clinically stable pediatric patients with posterior fossa tumors and hydrocephalus may not be associated with improved radiological or clinical outcomes.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

Abbreviations

CSF:

Cerebrospinal fluid

ETV:

Endoscopic third ventriculostomy

EVD:

External ventricular drain

ICP:

Intracranial pressure

MRI:

Magnetic resonance imaging

PFT:

Posterior fossa tumor

VP:

Ventriculoperitoneal

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Author information

Authors and Affiliations

  1. Division of Neurosurgery, Michigan State University, Spectrum Health, Grand Rapids, MI, USA

    Leonard H. Verhey

  2. McMaster Pediatric Brain Tumor Study Group, McMaster University, Hamilton, ON, Canada

    Leonard H. Verhey, Arjuna Maharaj, Nikunj Patel, Branavan Manoranjan, Olufemi Ajani, Adam Fleming, Forough Farrokhyar, Sheila K. Singh & Blake Yarascavitch

  3. Department of Surgery, McMaster University, Hamilton, ON, Canada

    Olufemi Ajani, Forough Farrokhyar, Sheila K. Singh & Blake Yarascavitch

  4. Department of Pediatrics, McMaster University, Hamilton, ON, Canada

    Adam Fleming

  5. Department of Health Research Methodology, McMaster University, Hamilton, ON, Canada

    Forough Farrokhyar

  6. Section of Neurosurgery, Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada

    Branavan Manoranjan

  7. Division of Pediatric Neurosurgery, McMaster Children’s Hospital, Hamilton, ON, Canada

    Olufemi Ajani, Sheila K. Singh & Blake Yarascavitch

Authors
  1. Leonard H. Verhey
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Consortia

on behalf the Pediatric Brain Tumor Study Group

Contributions

LHV: conception, data analysis and interpretation, drafting and revising manuscript, final manuscript approval, and ensuring accuracy and integrity of the work; AM: data acquisition and analysis, drafting and revising manuscript, and final manuscript approval; NP: data acquisition and analysis, and final manuscript approval; BM: drafting and revising manuscript, and final manuscript approval; OA: conception, revising manuscript, and final manuscript approval; AF: conception, revising manuscript, final manuscript approval, and ensuring accuracy and integrity of the work; FF: data interpretation, revising manuscript, and final manuscript approval; SKS: conception, data interpretation, revising manuscript, final manuscript approval, and ensuring accuracy and integrity of the work; BY: conception, data interpretation, revising manuscript, final manuscript approval, and ensuring accuracy and integrity of the work.

Corresponding author

Correspondence to Blake Yarascavitch.

Ethics declarations

Ethics approval and consent to participate

This study was performed in accordance with the ethical standards of McMaster University, and with the principles of the 1964 Declaration of Helsinki and its later amendments. Given the retrospective nature of this study, the Research Ethics Boards waived the need for consent to participate.

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Not applicable.

Conflict of interest

The authors have no financial or proprietary interests in any of the material discussed in this paper.

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Verhey, L.H., Maharaj, A., Patel, N. et al. External ventricular drainage in the management of pediatric patients with posterior fossa tumors and hydrocephalus: a retrospective cohort study. Childs Nerv Syst 39, 887–894 (2023). https://doi.org/10.1007/s00381-022-05818-8

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  • DOI: https://doi.org/10.1007/s00381-022-05818-8

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