Child's Nervous System

, Volume 35, Issue 5, pp 789–794 | Cite as

Endoscopic third ventriculostomy prior to resection of posterior fossa tumors in children

  • Fabio Frisoli
  • Michael Kakareka
  • Kristina A. Cole
  • Angela J Waanders
  • Phillip B. Storm
  • Shih-Shan LangEmail author
Original Article



Hydrocephalus is a common presenting symptom of pediatric posterior fossa tumors and often requires permanent cerebrospinal fluid diversion even after resection. Endoscopic third ventriculostomy (ETV) is a well-established treatment of obstructive hydrocephalus in children. The objective of this study is to demonstrate that ETV prior to posterior fossa tumor resection decreases the rate of postoperative ventriculoperitonal shunt (VPS) placement.


We performed a retrospective analysis of patients who presented with hydrocephalus and underwent posterior fossa tumor resection between 2005 and 2016 excluding pineal and tectal tumors. The rate of postoperative VPS placement was compared in patients who underwent resection and had a VPS placed perioperatively (historical controls) with patients who underwent ETV prior to resection. The two groups were matched for demographics, tumor histology, and tumor location. We also performed a literature review of prior studies that examined the role of ETV in pediatric posterior fossa tumors.


Thirty-six patients in the control group were compared to 38 patients in our study. The patients were matched across all variables (age, gender, tumor histology, and tumor locations). The rate of postoperative VPS placement was 31% in the control group compared to 16% in the ETV group. No complications were encountered during ETV.


Endoscopic third ventriculostomy prior to posterior fossa tumor resection in children appears to decrease the rate of postoperative VPS placement. Given its efficacy and safety, ETV should be considered prior to tumor resection in these patients.


Endoscopic third ventriculostomy Posterior fossa tumor Pediatrics Ventriculoperitoneal shunt 



Endoscopic third ventriculostomy


Cerebrospinal fluid


Ventriculoperitoneal shunt


External ventricular drainage


Compliance with ethical standards

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.


  1. 1.
    Albright L, Reigel DH (1977) Management of hydrocephalus secondary to posterior fossa tumors. J Neurosurg 46:52–55CrossRefPubMedGoogle Scholar
  2. 2.
    Azab W, Al-Shiekh T, Yahia A (2013) Preoperative endoscopic third ventriculostomy in children with posterior fossa tumors: an institution experience. Turk Neurosurg 23(3):359–365PubMedGoogle Scholar
  3. 3.
    Bell WE, McCormick WF (1972) Increased intracranial pressure in children. Major Probl Clin Pediatr 8:3–260PubMedGoogle Scholar
  4. 4.
    Bhatia R, Tahir M, Chandler CL (2009) The management of hydrocephalus in children with posterior fossa tumours: the role of pre-resectional endoscopic third ventriculostomy. Pediatr Neurosurg 45:186–191CrossRefPubMedGoogle Scholar
  5. 5.
    Bognar L, Borgulya G, Benke P, Madarassy G (2003) Analysis of CSF shunting procedure requirement in children with posterior fossa tumors. Childs Nerv Syst 19:332–336CrossRefPubMedGoogle Scholar
  6. 6.
    Culley DJ, Berger MS, Shaw D, Geyer R (1994) An analysis of factors determining the need for ventriculoperitoneal shunts after posterior fossa tumor surgery in children. Neurosurgery 34:402–407; discussion 407-408CrossRefPubMedGoogle Scholar
  7. 7.
    Dewan MC, Lim J, Shannon CN, Wellons JC (2017) The durability of endoscopic third ventriculostomy and ventriculoperitoneal shunts in children with hydrocephalus following posterior fossa tumor resection: a systematic review and time-to-failure analysis. J Neurosurg Pediatr 19:578–584CrossRefPubMedGoogle Scholar
  8. 8.
    Dias MS, Albright AL (1989) Management of hydrocephalus complicating childhood posterior fossa tumors. Pediatr Neurosci 15:283–289; discussion 290CrossRefPubMedGoogle Scholar
  9. 9.
    Due-Tonnessen BJ, Helseth E (2007) Management of hydrocephalus in children with posterior fossa tumors: role of tumor surgery. Pediatr Neurosurg 43:92–96CrossRefPubMedGoogle Scholar
  10. 10.
    El Beltagy MA, Kamal HM, Taha H, Awad M, El Khateeb N (2010) Endoscopic third ventriculostomy before tumor surgery in children with posterior fossa tumors, CCHE experience. Childs Nerv Syst 26:1699–1704CrossRefPubMedGoogle Scholar
  11. 11.
    Fournier L, Delion M, Esvan M, Carli E, Chappe C, Mercier P, Menei P, Riffaud L (2017) Management of hydrocephalus in pediatric metastatic tumors of the posterior fossa at presentation. Childs Nerv Syst 33:1473–1480mCrossRefPubMedGoogle Scholar
  12. 12.
    Fritsch MJ, Doerner L, Kienke S, Mehdorn HM (2005) Hydrocephalus in children with posterior fossa tumors: role of endoscopic third ventriculostomy. J Neurosurg 103:40–42PubMedGoogle Scholar
  13. 13.
    Gangemi M, Mascari C, Maiuri F, Donati P, Longatti PL (2007) Long-term outcome of endoscopic third ventriculostomy in obstructive hydrocephalus. Minim Invasive Neurosurgery 50(5):265–269CrossRefGoogle Scholar
  14. 14.
    Ghandour El NM (2011) Endoscopic third ventriculostomy versus ventriculoperitoneal shunt in the treatment of obstructive hydrocephalus due to posterior fossa tumors in children. Childs Nerv Syst 27:117–126CrossRefGoogle Scholar
  15. 15.
    Gol A, Mc KW (1959) The cerebellar astrocytomas: a report on 98 verified cases. J Neurosurg 16:287–296CrossRefPubMedGoogle Scholar
  16. 16.
    Javadpour M, Mallucci C (2004) The role of neuroendoscopy in the management of tectal gliomas. Childs Nerv Syst 20:852–857CrossRefPubMedGoogle Scholar
  17. 17.
    Klimo P Jr, Goumnerova LC (2006) Endoscopic third ventriculocisternostomy for brainstem tumors. J Neurosurg 105:271–274CrossRefPubMedGoogle Scholar
  18. 18.
    Kobayashi N, Ogiwara H (2016) Endoscopic third ventriculostomy for hydrocephalus in brainstem glioma: a cases series. Childs Nerv Syst 32:1251–1255CrossRefPubMedGoogle Scholar
  19. 19.
    Kumar V, Phipps K, Harkness W, Hayward RD (1996) Ventriculo-peritoneal shunt requirement in children with posterior fossa tumours: an 11-year audit. Br J Neurosurg 10:467–470CrossRefPubMedGoogle Scholar
  20. 20.
    Lee M, Wisoff JH, Abbott R, Freed D, Epstein FJ (1994) Management of hydrocephalus in children with medulloblastoma: prognostic factors for shunting. Pediatr Neurosurg 20:240–247CrossRefPubMedGoogle Scholar
  21. 21.
    Li KW, Roonprapunt C, Lawson HC, Abbott IR, Wisoff J, Epstein F, Jallo GI (2005) Endoscopic third ventriculostomy for hydrocephalus associated with tectal gliomas. Neurosurg Focus 18:E2CrossRefPubMedGoogle Scholar
  22. 22.
    Mohanty S, Rout SS, Sarangi GS, Devi K (2016) Choroid plexus papilloma from the temoral horn with a bilateral hypersecretory hydrocephalus: a case report and review of literature. World J Oncol 7(2–3):51–56CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Morelli D, Pirotte B, Lubansu A, Detemmerman D, Aeby A, Fricx C, Berre J, David P, Brotchi J (2005) Persistent hydrocephalus after early surgical management of posterior fossa tumors in children: is routine preoperative endoscopic third ventriculostomy justified? J Neurosurg 103:247–252PubMedGoogle Scholar
  24. 24.
    O'Brien DF, Hayhurst C, Pizer B, Mallucci CL (2006) Outcomes in patients undergoing single-trajectory endoscopic third ventriculostomy and endoscopic biopsy for midline tumors presenting with obstructive hydrocephalus. J Neurosurg 105:219–226PubMedGoogle Scholar
  25. 25.
    Raimondi AJ, Tomita T (1981) Hydrocephalus and infratentorial tumors: incidence, clinical picture, and treatment. J Neurosurg 55:174–182CrossRefPubMedGoogle Scholar
  26. 26.
    Ray P, Jallo GI, Kim RY, Kim BS, Wilson S, Kothbauer K, Abbott R (2005) Endoscopic third ventriculostomy for tumor-related hydrocephalus in a pediatric population. Neurosurg Focus 19:E8CrossRefPubMedGoogle Scholar
  27. 27.
    Ruggiero C, Cinali G, Spennato P, Ferdinando A, Cianciulli E, Trischitta V, Maggi G (2004) Endoscopic third ventriculostomy in the treatment of hydrocephalus in posterior fossa tumors in children. Childs Nerve Syst 20:828–833CrossRefGoogle Scholar
  28. 28.
    Sainte-Rose C, Cinalli G, Roux FE, Maixner R, Chumas PD, Mansour M, Carpentier A, Bourgeois M, Zerah M, Pierre-Kahn A, Renier D (2001) Management of hydrocephalus in pediatric patients with posterior fossa tumors: the role of endoscopic third ventriculostomy. J Neurosurg 95:791–797CrossRefPubMedGoogle Scholar
  29. 29.
    Santos de Oliveira R, Barros Juca CE, Valera ET, Machado HR (2008) Hydrocephalus in posterior fossa tumors in children. Are there factors that determine a need for permanent cerebrospinal fluid diversion? Childs Nerv Syst 24:1397–1403CrossRefPubMedGoogle Scholar
  30. 30.
    Tamburrini G, Massimi L, Caldarelli M, Di Rocco C (2008) Antibiotic impregnated external ventricular drainage and third ventriculostomy in the management of hydrocephalus associated with posterior cranial fossa tumours. Acta Neurochir 150:1049CrossRefPubMedGoogle Scholar
  31. 31.
    Tamburrini G, Pettorni BL, Massimi L, Caldarelli M, Di Rocco C (2008) Endoscopic third ventriculostomy: the best option in the treatment of persistent hydrocephalus after posterior cranial fossa tumour removal? Childs Nerv System 24:1405CrossRefGoogle Scholar
  32. 32.
    Wong TT, Chen HH, Liang ML, Yen YS, Chang FC (2011) Neuroendoscopy in the management of pineal tumors. Childs Nerv Syst 27:949–959CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Fabio Frisoli
    • 1
    • 2
  • Michael Kakareka
    • 2
    • 3
  • Kristina A. Cole
    • 4
  • Angela J Waanders
    • 5
  • Phillip B. Storm
    • 2
    • 6
  • Shih-Shan Lang
    • 2
    • 6
    Email author
  1. 1.Department of NeurosurgeryNew York University School of MedicineNew York CityUSA
  2. 2.Division of Neurosurgery, Children’s Hospital of Philadelphia, Department of Neurosurgery, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaUSA
  3. 3.Department of NeurosurgeryPhiladelphia College of Osteopathic MedicinePhiladelphiaUSA
  4. 4.Division of Oncology, Children’s Hospital of Philadelphia, Department of Pediatrics, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaUSA
  5. 5.Division of Hematology, Oncology, and Stem Cell Transplant, Ann & Robert H Lurie Children’s Hospital of Chicago, Department of PediatricsFeinberg School of Medicine Northwestern UniversityChicagoUSA
  6. 6.Center for Data Driven Discovery in BiomedicineChildren’s Hospital of PhiladelphiaPhiladelphiaUSA

Personalised recommendations