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Shall we treat hydrocephalus associated to brain stem glioma in children?

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Abstract

Purpose/method

Brain stem glioma accounts for 6–9% of brain tumors in children. Tumor progression may lead to CSF pathway obstruction and development of hydrocephalus. We retrospectively reviewed charts of patients consecutively treated in our institution with diffuse intrinsic pontine glioma in order to assess incidence of hydrocephalus, its management, and its impact on overall survival. All patients had brain stem glioma not amenable to surgery. Cases with exophytic brain stem glioma were excluded.

Results

Fifty-one children were treated from January 2005 to December 2010 for brain stem glioma in the Pediatric Neurosurgery Department of Necker Enfants Malades, Paris, France. Hydrocephalus occurred in 11 of them (22%). They were six boys and five girls; the average and median time from tumor diagnosis to onset of hydrocephalus were 5.3 and 3.2 months, respectively, while average and median time from onset of hydrocephalus to death were 5.3 and 2.8 months, respectively. Hydrocephalus was treated in nine patients by a ventriculoperitoneal (VP) shunt and in two patients by an endoscopic third ventriculostomy. Because of early failure, a VP shunt was implanted in one child.

Conclusion

The overall 1-year survival rate was 33%. Survival rate of patients with such obstructive hydrocephalus was not significantly different from patients harboring brain stem glioma who did not develop hydrocephalus. Furthermore, hydrocephalus was not related to terminal tumor progression. Considering both risks and benefit of treatment, VP shunt could be proposed, on the base of our experience, as the first option in spite of the apparently obstructive nature of the hydrocephalus associated to a brain stem tumor.

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Authors and Affiliations

  1. Department of Paediatric Neurosurgery, Hôpital Necker Enfants Malades, APHP, 149, rue de sèvres, 75015, Paris, France

    Thomas Roujeau, Federico Di Rocco, Stephanie Puget, Christian Sainte Rose & Michel Zerah

  2. Pediatric Neuro-Oncology Department, Institut Gustave Roussy, Villejuif, Paris, France

    Christelle Dufour

  3. Pediatric Neuro-Oncology Department, Institut Curie, Paris, France

    Franck Bourdeaut

Authors
  1. Thomas Roujeau
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  2. Federico Di Rocco
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  3. Christelle Dufour
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  4. Franck Bourdeaut
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  5. Stephanie Puget
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  6. Christian Sainte Rose
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  7. Michel Zerah
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Correspondence to Thomas Roujeau.

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Roujeau, T., Di Rocco, F., Dufour, C. et al. Shall we treat hydrocephalus associated to brain stem glioma in children?. Childs Nerv Syst 27, 1735–1739 (2011). https://doi.org/10.1007/s00381-011-1538-2

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  • DOI: https://doi.org/10.1007/s00381-011-1538-2

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