Abstract
Background
Obstructive hydrocephalus is the most common complication of intracranial germ cell tumors (IGCTs). Although ventriculoperitoneal shunts (VPSs) were previously used for treating this condition, they have recently been replaced by endoscopic third ventriculostomy (ETV), as the latter can avoid various complications caused by a VPS and can preserve physiological cerebrospinal fluid (CSF) dynamics. Therefore, if a VPS malfunctioned in patients who had previously been treated for IGCTs, it seems reasonable to consider removing the problematic VPS, followed by ETV, as long as magnetic resonance imaging reveals third ventricle floor ballooning and the cause of obstruction in the ventricular system, which are indicators for ETV.
Case Presentation and Discussion
Here, we present the cases of three patients who underwent simultaneous removal of malfunctioning VPSs and ETV, more than 20 years (range 20–27 years) after initial treatment for IGCT and relevant obstructive hydrocephalus. Despite a relatively long shunt dependency, their obstructive hydrocephalus was well-managed by ETV, probably because CSF absorptive capacity remained intact after IGCT ablation by radio-chemotherapy.
Conclusion
Patients with previously treated IGCTs can thus be released from the need for a VPS, regardless of long-term shunt dependency.
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The Institutional Review Board of the Kanazawa University Hospital (#1718-2015) approved this retrospective review of patients’ medical records.
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The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper. This work was supported by KAKENHI (Grant-in-Aid for Exploratory Research to D.K.).
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Kita, D., Hayashi, Y., Fukui, I. et al. Simultaneous ventriculoperitoneal shunt removal and endoscopic third ventriculostomy for three patients previously treated for intracranial germ cell tumors more than 20 years ago. Childs Nerv Syst 32, 1543–1547 (2016). https://doi.org/10.1007/s00381-016-3055-9
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DOI: https://doi.org/10.1007/s00381-016-3055-9