Acta Neurochirurgica

, Volume 160, Issue 5, pp 1063–1071 | Cite as

Frequency and treatment of hydrocephalus prior to and after posterior fossa tumor surgery in adult patients

  • Sascha Marx
  • Maresa Reinfelder
  • Marc Matthes
  • Henry W. S. Schroeder
  • Joerg Baldauf
Original Article - Brain Tumors



There is paucity of information about the frequency of hydrocephalus prior to and after posterior fossa tumor surgery in adult patients and about the best way it should be managed. The present study was conducted to determine the frequency of hydrocephalus prior to and after posterior fossa tumor surgery in adult patients as well as the value of an endoscopic third ventriculostomy (ETV) prior to posterior fossa tumor surgery with regard to the rate of perioperative complications and persistent hydrocephalus.


A single-institution retrospective chart review of all posterior fossa tumor surgeries of our department in a 10-year period (2005 to 2014) has been done.


Fifty-two of 243 adult patients with posterior fossa tumors presented with hydrocephalus at the time of admission prior to tumor surgery. 39/52 received early tumor surgery, 11/52 an ETV prior to tumor surgery and in 2/52 an external ventricular drainage (EVD) was inserted prior to tumor surgery. 3/52 patients required a permanent cerebrospinal fluid (CSF) diverting procedure for persistent hydrocephalus after tumor removal. One hundred ninety-one patients did not demonstrate a hydrocephalus before surgical treatment and four of them developed a post-resection hydrocephalus.


The frequency of hydrocephalus prior to posterior fossa tumor surgery in adult patients is 21.4% and therefore much lower than in respective reports of pediatric patients. The risk of persistent hydrocephalus and newly developed hydrocephalus after tumor surgery was very low, too (5.7 and 2.1%, respectively). An ETV is not justified in every adult patient prior to posterior fossa tumor surgery.


Posterior fossa tumor Hydrocephalus Adult Brain tumor Endoscopic third ventriculostomy Tumor-related hydrocephalus Persistent hydrocephalus Frequency of hydrocephalus 



No funding was received for this research.

Compliance with ethical standards



Conflicts of interest

Henry W. S. Schroeder is a consultant to Karl Storz GmbH & Co. KG, Tuttlingen, Germany.

All other authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (name of institute/committee) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.


  1. 1.
    Atlas MD, Perez de Tagle JR, Cook JA, Sheehy JP, Fagan PA (1996) Evolution of the management of hydrocephalus associated with acoustic neuroma. Laryngoscope 106:204–206CrossRefPubMedGoogle Scholar
  2. 2.
    Briggs RJ, Shelton C, Kwartler JA, Hitselberger W (1993) Management of hydrocephalus resulting from acoustic neuromas. Otolaryngol Head Neck Surg 109:1020–1024CrossRefPubMedGoogle Scholar
  3. 3.
    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 19:578–584CrossRefPubMedGoogle Scholar
  4. 4.
    Di Rocco F, Juca CE, Zerah M, Sainte-Rose C (2013) Endoscopic third ventriculostomy and posterior fossa tumors. World Neurosurg 79(S18):e15–e19Google Scholar
  5. 5.
    Di Vincenzo J, Keiner D, Gaab MR, Schroeder HW, Oertel JM (2014) Endoscopic third ventriculostomy: preoperative considerations and intraoperative strategy based on 300 procedures. J Neurol Surg A Cent Eur Neurosurg 75:20–30CrossRefPubMedGoogle Scholar
  6. 6.
    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
  7. 7.
    Fukuda M, Takao T, Hiraishi T, Yoshimura J, Yajima N, Saito A et al (2014) Clinical factors predicting outcomes after surgical resection for sporadic cerebellar hemangioblastomas. World Neurosurg 82:815–821CrossRefPubMedGoogle Scholar
  8. 8.
    Gangemi M, Mascari C, Maiuri F, Godano U, Donati P, Longatti PL (2007) Long-term outcome of endoscopic third ventriculostomy in obstructive hydrocephalus. Minim Invasive Neurosurg 50:265–269CrossRefPubMedGoogle Scholar
  9. 9.
    Ghani E, Zaidi GI, Nadeem M, Rehman L, Noman MA, Khaleeq Uz Z (2003) Role of cerebrospinal fluid diversion in posterior fossa tumor surgery. J Coll Physicians Surg Pak 13:333–336PubMedGoogle Scholar
  10. 10.
    Grand W, Leonardo J, Chamczuk AJ, Korus AJ (2016) Endoscopic third ventriculostomy in 250 adults with hydrocephalus: patient selection, outcomes, and complications. Neurosurgery 78:109–119CrossRefPubMedGoogle Scholar
  11. 11.
    Harati A, Scheufler KM, Schultheiss R, Tonkal A, Harati K, Oni P et al (2017) Clinical features, microsurgical treatment, and outcome of vestibular schwannoma with brainstem compression. Surg Neurol Int 8:45CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Isaacs AM, Bezchlibnyk YB, Yong H, Koshy D, Urbaneja G, Hader WJ et al (2016) Endoscopic third ventriculostomy for treatment of adult hydrocephalus: long-term follow-up of 163 patients. Neurosurg Focus 41:E3CrossRefPubMedGoogle Scholar
  13. 13.
    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
  14. 14.
    Le Fournier L, Delion M, Esvan M, De Carli E, Chappe C, Mercier P, et al (2017) Management of hydrocephalus in pediatric metastatic tumors of the posterior fossa at presentation. Childs Nerv Syst 33(9):1473–1480Google Scholar
  15. 15.
    Legnani FG, Saladino A, Casali C, Vetrano IG, Varisco M, Mattei L et al (2013) Craniotomy vs. craniectomy for posterior fossa tumors: a prospective study to evaluate complications after surgery. Acta Neurochir 155:2281–2286CrossRefPubMedGoogle Scholar
  16. 16.
    Lin CT, Riva-Cambrin JK (2015) Management of posterior fossa tumors and hydrocephalus in children: a review. Childs Nerv Syst 31:1781–1789CrossRefPubMedGoogle Scholar
  17. 17.
    Mangubat EZ, Chan M, Ruland S, Roitberg BZ (2009) Hydrocephalus in posterior fossa lesions: ventriculostomy and permanent shunt rates by diagnosis. Neurol Res 31:668–673CrossRefPubMedGoogle Scholar
  18. 18.
    Marx S, A; Manwaring, J, El Refaee, E; Fleck, SK; Fritsch, M; Gaab, MR; Schroeder, HWS; Baldauf, J (2017) Endoscopic Third Ventriculostomy prior to posterior fossa tumor surgery in adult patients. J Neurol Surg A Cent Eur Neurosurg.
  19. 19.
    Morelli D, Pirotte B, Lubansu A, Detemmerman D, Aeby A, Fricx C et al (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
  20. 20.
    Nguyen TT, Smith MV, Rodziewicz GS, Lemke SM (1999) Hydrocephalus caused by metastatic brain lesions: treatment by third ventriculostomy. J Neurol Neurosurg Psychiatry 67:552–553CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Niu L, Zhang Y, Li Q, Dai J, Yin H, Duan L et al (2016) The analysis of correlative factors affecting long-term outcomes in patients with Solid Cerebellar Hemangioblastomas. Clin Neurol Neurosurg 150:59–66CrossRefPubMedGoogle Scholar
  22. 22.
    Papo I, Caruselli G, Luongo A (1982) External ventricular drainage in the management of posterior fossa tumors in children and adolescents. Neurosurgery 10:13–15PubMedGoogle Scholar
  23. 23.
    Pirouzmand F, Tator CH, Rutka J (2001) Management of hydrocephalus associated with vestibular schwannoma and other cerebellopontine angle tumors. Neurosurgery 48:1246–1253 discussion 1253-1244PubMedGoogle Scholar
  24. 24.
    Riva-Cambrin J, Detsky AS, Lamberti-Pasculli M, Sargent MA, Armstrong D, Moineddin R et al (2009) Predicting postresection hydrocephalus in pediatric patients with posterior fossa tumors. J Neurosurg Pediatr 3:378–385CrossRefPubMedGoogle Scholar
  25. 25.
    Ruggiero C, Cinalli G, Spennato P, Aliberti F, Cianciulli E, Trischitta V et al (2004) Endoscopic third ventriculostomy in the treatment of hydrocephalus in posterior fossa tumors in children. Childs Nerv Syst 20:828–833CrossRefPubMedGoogle Scholar
  26. 26.
    Sacko O, Boetto S, Lauwers-Cances V, Dupuy M, Roux FE (2010) Endoscopic third ventriculostomy: outcome analysis in 368 procedures. J Neurosurg Pediatr 5:68–74CrossRefPubMedGoogle Scholar
  27. 27.
    Sainte-Rose C, Cinalli G, Roux FE, Maixner R, Chumas PD, Mansour M et al (2001) Management of hydrocephalus in pediatric patients with posterior fossa tumors: the role of endoscopic third ventriculostomy. J Neurosurg 95:791–797CrossRefPubMedGoogle Scholar
  28. 28.
    Schmid UD, Seiler RW (1986) Management of obstructive hydrocephalus secondary to posterior fossa tumors by steroids and subcutaneous ventricular catheter reservoir. J Neurosurg 65:649–653CrossRefPubMedGoogle Scholar
  29. 29.
    Schneider C, Ramaswamy V, Kulkarni AV, Rutka JT, Remke M, Tabori U et al (2015) Clinical implications of medulloblastoma subgroups: incidence of CSF diversion surgery. J Neurosurg Pediatr 15:236–242CrossRefPubMedGoogle Scholar
  30. 30.
    Sunderland GJ, Jenkinson MD, Zakaria R (2016) Surgical management of posterior fossa metastases. J Neuro-Oncol 130:535–542CrossRefGoogle Scholar
  31. 31.
    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 24:1405–1412CrossRefPubMedGoogle Scholar
  32. 32.
    Taniguchi M, Nakai T, Kohta M, Kimura H, Kohmura E (2016) Communicating hydrocephalus associated with small- to medium-sized vestibular schwannomas: clinical significance of the tumor apparent diffusion coefficient map. World Neurosurg 94:261–267CrossRefPubMedGoogle Scholar
  33. 33.
    Taylor WA, Todd NV, Leighton SE (1992) CSF drainage in patients with posterior fossa tumours. Acta Neurochir 117:1–6CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Austria, part of Springer Nature 2018

Authors and Affiliations

  • Sascha Marx
    • 1
  • Maresa Reinfelder
    • 1
  • Marc Matthes
    • 1
  • Henry W. S. Schroeder
    • 1
  • Joerg Baldauf
    • 1
  1. 1.Department of NeurosurgeryUniversity Medicine GreifswaldGreifswaldGermany

Personalised recommendations