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Child's Nervous System

, Volume 35, Issue 5, pp 779–788 | Cite as

Predictive factors associated with ventriculoperitoneal shunting after posterior fossa tumor surgery in children

  • Leonie Johanna Helmbold
  • Gertrud Kammler
  • Jan Regelsberger
  • Friederike Sophie Fritzsche
  • Pedram Emami
  • Ulrich Schüller
  • Kara KrajewskiEmail author
Original Article
  • 24 Downloads

Abstract

Purpose

The aim of the study was to evaluate established risk factors and define new inflammation-associated factors associated with postoperative ventriculoperitoneal shunt placement.

Methods

The electronic medical records of children who underwent surgery for a tumor in the posterior fossa between January 2009 and January 2018 were retrospectively analyzed. Factors evaluated include age, clinical symptoms, tumor type, extent of surgical tumor resection, treatment with EVD and/or ETV, radiological findings, postoperative serum CRP, and leucocyte levels. Tumor tissue was stained immunohistochemically with antibodies against CD3, and leucocyte counts were performed. Patients with pre- or postoperative signs of infection or confirmation of a concurrent infection were excluded from some analyses.

Results

Seventy patients ages 0.4–20.8 years (median, 8.2) were included. Forty-five of 70 (65.3%) presented postoperative radiological signs of hydrocephalus. Fifteen of 70 (21.4%) patients required shunt placement postoperatively. Shunt placement was significantly associated with age < 3 years at diagnosis (p = 0.013), perioperative EVD placement (p < 0.001), signs of hydrocephalus in postoperative imaging (p = 0.047), a frontooccipital horn ratio (FOHR) > 0.46 within the first 72 h postoperatively (p < 0.001), and the presence of intraventricular blood postoperatively (p = 0.007). Six patients who underwent shunting had serum CRP levels > 40 mg/l (p = 0.030) within the first 48 h postoperatively. Tumor type or extent of resection did not correlate with shunt placement.

Conclusions

Several established and new factors associated with shunt placement after posterior fossa tumor surgery could be identified. Additional studies are needed to explore the aseptic inflammation pathways involved with increased CRP levels and shunt placement.

Keywords

Inflammation markers CRP Intraventricular blood Hydrocephalus 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Ahmann PA, Lazzara A, Dykes FD, Brann AW Jr, Schwartz JF (1980) Intraventricular hemorrhage in the high-risk preterm infant: incidence and outcome. Ann Neurol 7:118–124.  https://doi.org/10.1002/ana.410070205 CrossRefGoogle Scholar
  2. 2.
    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 45:186–191.  https://doi.org/10.1159/000222668 CrossRefGoogle Scholar
  3. 3.
    Bognar L, Borgulya G, Benke P, Madarassy G (2003) Analysis of CSF shunting procedure requirement in children with posterior fossa tumors. Childs Nerv Syst 19:332–336.  https://doi.org/10.1007/s00381-003-0745-x CrossRefGoogle Scholar
  4. 4.
    Chaplin ER, Goldstein GW, Myerberg DZ, Hunt JV, Tooley WH (1980) Posthemorrhagic hydrocephalus in the preterm infant. Pediatrics 65:901–909Google Scholar
  5. 5.
    Chaudhry SR, Stoffel-Wagner B, Kinfe TM, Guresir E, Vatter H, Dietrich D, Lamprecht A, Muhammad S (2017) Elevated systemic IL-6 levels in patients with aneurysmal subarachnoid hemorrhage is an unspecific marker for post-SAH complications. Int J Mol Sci 18.  https://doi.org/10.3390/ijms18122580
  6. 6.
    Chen Q, Feng Z, Tan Q, Guo J, Tang J, Tan L, Feng H, Chen Z (2017) Post-hemorrhagic hydrocephalus: recent advances and new therapeutic insights. J Neurol Sci 375:220–230.  https://doi.org/10.1016/j.jns.2017.01.072 CrossRefGoogle Scholar
  7. 7.
    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 407-408CrossRefGoogle Scholar
  8. 8.
    de Ribaupierre S, Rilliet B, Vernet O, Regli L, Villemure JG (2007) Third ventriculostomy vs ventriculoperitoneal shunt in pediatric obstructive hydrocephalus: results from a Swiss series and literature review. Childs Nerv Syst 23:527–533.  https://doi.org/10.1007/s00381-006-0283-4 CrossRefGoogle Scholar
  9. 9.
    Dewan MC, Lim J, Shannon CN, Wellons JC 3rd (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 19:1–7.  https://doi.org/10.3171/2017.1.peds16536 CrossRefGoogle Scholar
  10. 10.
    Di Rocco F, Jucá CE, Zerah M, Sainte-Rose C (2013) Endoscopic third ventriculostomy and posterior fossa tumors. World Neurosurg 79(2 Suppl):15–19Google Scholar
  11. 11.
    Dias MS, Albright AL (1989) Management of hydrocephalus complicating childhood posterior fossa tumors. Pediatr Neurosci 15:283–289; discussion 290CrossRefGoogle Scholar
  12. 12.
    Due-Tonnessen BJ, Helseth E (2007) Management of hydrocephalus in children with posterior fossa tumors: role of tumor surgery. Pediatr Neurosurg 43:92–96.  https://doi.org/10.1159/000098379 CrossRefGoogle Scholar
  13. 13.
    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 26:1699–1704CrossRefGoogle Scholar
  14. 14.
    Foreman P, Mc-Clugage S 3rd, Naftel R, Griessenauer CJ, Ditty BJ, Agee BS, Riva-Cambrin J, Wellons J 3rd (2013) Validation and modification of a predictive model of postresection hydrocephalus in pediatric patients with posterior fossa tumors. J Neurosurg Pediatr 12:220–226.  https://doi.org/10.3171/2013.5.peds1371 CrossRefGoogle Scholar
  15. 15.
    Gopalakrishnan CV, Dhakoji A, Menon G, Nair S (2012) Factors predicting the need for cerebrospinal fluid diversion following posterior fossa tumor surgery in children. Pediatr Neurosurg 48:93–101.  https://doi.org/10.1159/000343009 CrossRefGoogle Scholar
  16. 16.
    Gram M, Sveinsdottir S, Cinthio M, Sveinsdottir K, Hansson SR, Morgelin M, Akerstrom B, Ley D (2014) Extracellular hemoglobin - mediator of inflammation and cell death in the choroid plexus following preterm intraventricular hemorrhage. J Neuroinflammation 11:200.  https://doi.org/10.1186/s12974-014-0200-9 CrossRefGoogle Scholar
  17. 17.
    Habiyaremye G, Morales DM, Morgan CD, McAllister JP, CreveCoeur TS, Han RH, Gabir M, Baksh B, Mercer D, Limbrick DD Jr (2017) Chemokine and cytokine levels in the lumbar cerebrospinal fluid of preterm infants with post-hemorrhagic hydrocephalus. Fluids Barriers CNS 14:35.  https://doi.org/10.1186/s12987-017-0083-0 CrossRefGoogle Scholar
  18. 18.
    Juvela S, Kuhmonen J, Siironen J (2012) C-reactive protein as predictor for poor outcome after aneurysmal subarachnoid haemorrhage. Acta Neurochir 154:397–404.  https://doi.org/10.1007/s00701-011-1243-7 CrossRefGoogle Scholar
  19. 19.
    Karimy JK, Zhang J, Kurland DB, Theriault BC, Duran D, Stokum JA, Furey CG, Zhou X, Mansuri MS, Montejo J, Vera A, DiLuna ML, Delpire E, Alper SL, Gunel M, Gerzanich V, Medzhitov R, Simard JM, Kahle KT (2017) Inflammation-dependent cerebrospinal fluid hypersecretion by the choroid plexus epithelium in posthemorrhagic hydrocephalus. Nat Med 23:997–1003.  https://doi.org/10.1038/nm.4361 CrossRefGoogle Scholar
  20. 20.
    Kestle JR, Riva-Cambrin J, Wellons JC 3rd, Kulkarni AV, Whitehead WE, Walker ML, Oakes WJ, Drake JM, Luerssen TG, Simon TD, Holubkov R, Hydrocephalus Clinical Research N (2011) A standardized protocol to reduce cerebrospinal fluid shunt infection: the Hydrocephalus Clinical Research Network Quality Improvement Initiative. J Neurosurg Pediatr 8:22–29.  https://doi.org/10.3171/2011.4.PEDS10551 CrossRefGoogle Scholar
  21. 21.
    Killer M, Arthur A, Al-Schameri AR, Barr J, Elbert D, Ladurner G, Shum J, Cruise G (2010) Cytokine and growth factor concentration in cerebrospinal fluid from patients with hydrocephalus following endovascular embolization of unruptured aneurysms in comparison with other types of hydrocephalus. Neurochem Res 35:1652–1658.  https://doi.org/10.1007/s11064-010-0226-z CrossRefGoogle Scholar
  22. 22.
    Kulkarni AV, Riva-Cambrin J, Butler J, Browd SR, Drake JM, Holubkov R, Kestle JR, Limbrick DD, Simon TD, Tamber MS, Wellons JC 3rd, Whitehead WE, Hydrocephalus Clinical Research N (2013) Outcomes of CSF shunting in children: comparison of Hydrocephalus Clinical Research Network cohort with historical controls. clinical article J Neurosurg Pediatr 12:334–338.  https://doi.org/10.3171/2013.7.PEDS12637 CrossRefGoogle Scholar
  23. 23.
    Kulkarni AV, Riva-Cambrin J, Holubkov R, Browd SR, Cochrane DD, Drake JM, Limbrick DD, Rozzelle CJ, Simon TD, Tamber MS, Wellons JC 3rd, Whitehead WE, Kestle JR (2016) Endoscopic third ventriculostomy in children: prospective, multicenter results from the Hydrocephalus Clinical Research Network. J Neurosurg Pediatr 18:423–429.  https://doi.org/10.3171/2016.4.peds163 CrossRefGoogle Scholar
  24. 24.
    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 10:467–470CrossRefGoogle Scholar
  25. 25.
    Lee M, Wisoff JH, Abbott R, Freed D, Epstein FJ (1994) Management of hydrocephalus in children with medulloblastoma: prognostic factors for shunting. Pediatr Neurosurg 20:240–247.  https://doi.org/10.1159/000120797 CrossRefGoogle Scholar
  26. 26.
    Merchant TE, Fouladi M (2005) Ependymoma: new therapeutic approaches including radiation and chemotherapy. J Neuro-Oncol 75:287–299.  https://doi.org/10.1007/s11060-005-6753-9 CrossRefGoogle Scholar
  27. 27.
    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 103:247–252.  https://doi.org/10.3171/ped.2005.103.3.0247 Google Scholar
  28. 28.
    Naureen I, Waheed Kh A, Rathore AW, Victor S, Mallucci C, Goodden JR, Chohan SN, Miyan JA (2014) Fingerprint changes in CSF composition associated with different aetiologies in human neonatal hydrocephalus: inflammatory cytokines. Childs Nerv Syst 30:1155–1164.  https://doi.org/10.1007/s00381-014-2415-6 CrossRefGoogle Scholar
  29. 29.
    O’Hayon BB, Drake JM, Ossip MG, Tuli S, Clarke M (1998) Frontal and occipital horn ratio: a linear estimate of ventricular size for multiple imaging modalities in pediatric hydrocephalus. Pediatr Neurosurg 29:245–249 doi:28730CrossRefGoogle Scholar
  30. 30.
    Papo I, Caruselli G, Luongo A (1982) External ventricular drainage in the management of posterior fossa tumors in children and adolescents. Neurosurgery 10:13–15Google Scholar
  31. 31.
    Rekate HL (2008) Shunt-related headaches: the slit ventricle syndromes. Childs Nerv Syst 24:423–430.  https://doi.org/10.1007/s00381-008-0579-7 CrossRefGoogle Scholar
  32. 32.
    Riva-Cambrin J, Detsky AS, Lamberti-Pasculli M, Sargent MA, Armstrong D, Moineddin R, Cochrane DD, Drake JM (2009) Predicting postresection hydrocephalus in pediatric patients with posterior fossa tumors. J Neurosurg Pediatr 3:378–385.  https://doi.org/10.3171/2009.1.PEDS08298 CrossRefGoogle Scholar
  33. 33.
    Ruggiero C, Cinalli G, Spennato P, Aliberti F, Cianciulli E, Trischitta V, Maggi G (2004) Endoscopic third ventriculostomy in the treatment of hydrocephalus in posterior fossa tumors in children. Childs Nerv Syst 20:828–833.  https://doi.org/10.1007/s00381-004-0938-y CrossRefGoogle Scholar
  34. 34.
    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 95:791–797CrossRefGoogle Scholar
  35. 35.
    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 24:1397–1403.  https://doi.org/10.1007/s00381-008-0649-x CrossRefGoogle Scholar
  36. 36.
    Savman K, Blennow M, Hagberg H, Tarkowski E, Thoresen M, Whitelaw A (2002) Cytokine response in cerebrospinal fluid from preterm infants with posthaemorrhagic ventricular dilatation. Acta Paediatr 91:1357–1363CrossRefGoogle Scholar
  37. 37.
    Schmid UD, Seiler RW (1986) Management of obstructive hydrocephalus secondary to posterior fossa tumors by steroids and subcutaneous ventricular catheter reservoir. J Neurosurg 65:649–653.  https://doi.org/10.3171/jns.1986.65.5.0649 CrossRefGoogle Scholar
  38. 38.
    Schneider C, Ramaswamy V, Kulkarni AV, Rutka JT, Remke M, Tabori U, Hawkins C, Bouffet E, Taylor MD (2015) Clinical implications of medulloblastoma subgroups: incidence of CSF diversion surgery. J Neurosurg Pediatr 15:236–242.  https://doi.org/10.3171/2014.9.PEDS14280 CrossRefGoogle Scholar
  39. 39.
    Tamburrini G, Pettorini 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 Syst 24:1405–1412.  https://doi.org/10.1007/s00381-008-0699-0 CrossRefGoogle Scholar
  40. 40.
    Wang L, Gao Z (2018) Expression of MMP-9 and IL-6 in patients with subarachnoid hemorrhage and the clinical significance. Exp Ther Med 15:1510–1514.  https://doi.org/10.3892/etm.2017.5553 Google Scholar

Copyright information

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

Authors and Affiliations

  1. 1.Department of NeurosurgeryUniversity Medical Center Hamburg-EppendorfHamburgGermany
  2. 2.Department of Neuropathology and Department of Hematology and Oncology, Research Institute Children’s Cancer Center HamburgUniversity Medical Center Hamburg-EppendorfHamburgGermany
  3. 3.Department of NeurosurgeryUniversity Medical Center Schleswig-HolsteinLübeckGermany

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