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Clinical course of ventriculoperitoneal shunting for hydrocephalus following glioblastoma surgery: a systematic review and meta-analysis

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Abstract

Background

Surgical resection of glioblastoma (GBM) remains a cornerstone in the current treatment paradigm. The postoperative evolution of hydrocephalus necessitating ventriculoperitoneal shunting (VPS) continues to be defined. Correspondingly the objective of this study was to aggregate pertinent metadata to better define the clinical course of VPS for hydrocephalus following glioblastoma surgery in light of contemporary management.

Methods

Searches of multiple electronic databases from inception to November 2023 were conducted following PRISMA guidelines. Articles were screened against pre-specified criteria. Outcomes were pooled by random-effects meta-analyses where possible.

Results

A total of 12 cohort studies satisfied all selection criteria, describing a total of 6,098 glioblastoma patients after surgery with a total of 261 (4%) of patients requiring postoperative VPS for hydrocephalus. Meta-analysis demonstrated the estimated pooled rate of symptomatic improvement following VPS was 78% (95% CI 66–88), and the estimated pooled rate of VPS revision was 24% (95% CI 16–33). Pooled time from index glioblastoma surgery to VPS surgery was 4.1 months (95% CI 2.8–5.3), and pooled survival time for index VPS surgery was 7.3 months (95% CI 5.4–9.4). Certainty of these outcomes were limited by the heterogenous and palliative nature of postoperative glioblastoma management.

Conclusions

Of the limited proportion of glioblastoma patients requiring VPS surgery for hydrocephalus after index surgery, 78% patients are expected to show symptom improvement, and 24% can expect to undergo revision surgery. An individualized approach to each patient is required to optimize both index glioblastoma and VPS surgeries to account for anatomy and goals of care given the poor prognosis of this tumor overall.

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Data availability

No datasets were generated or analysed during the current study.

References

  1. Stupp R, Mason WP, van den Bent MJ, Weller M, Fisher B, Taphoorn MJ et al (2005) Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. N Engl J Med 352(10):987–996. https://doi.org/10.1056/NEJMoa043330

    Article  CAS  PubMed  Google Scholar 

  2. Molinaro AM, Hervey-Jumper S, Morshed RA, Young J, Han SJ, Chunduru P et al (2020) Association of Maximal Extent of Resection of contrast-enhanced and non-contrast-enhanced Tumor with Survival within Molecular subgroups of patients with newly diagnosed Glioblastoma. JAMA Oncol 6(4):495–503. https://doi.org/10.1001/jamaoncol.2019.6143

    Article  PubMed  PubMed Central  Google Scholar 

  3. Kaplan JG, DeSouza TG, Farkash A, Shafran B, Pack D, Rehman F et al (1990) Leptomeningeal metastases: comparison of clinical features and laboratory data of solid tumors, Lymphomas and leukemias. J Neurooncol 9(3):225–229. https://doi.org/10.1007/bf02341153

    Article  CAS  PubMed  Google Scholar 

  4. Inamasu J, Nakamura Y, Saito R, Kuroshima Y, Mayanagi K, Orii M et al (2003) Postoperative communicating hydrocephalus in patients with supratentorial malignant glioma. Clin Neurol Neurosurg 106(1):9–15. https://doi.org/10.1016/s0303-8467(03)00060-x

    Article  PubMed  Google Scholar 

  5. El Rahal A, Cipriani D, Fung C, Hohenhaus M, Sveikata L, Straehle J et al (2022) Hydrocephalus Shunting in Supratentorial Glioblastoma: functional outcomes and management. Front Oncol 12:796105. https://doi.org/10.3389/fonc.2022.796105

    Article  PubMed  PubMed Central  Google Scholar 

  6. Moher D, Liberati A, Tetzlaff J, Althman D (2009) Preferred reporting items for systematic reviews and Meta-analyses: the PRISMA Statement. PloS Med 6(7):e1000097. doi:10.1371/.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Lu VM, Graffeo CS, Perry A, Link MJ, Meyer FB, Dawood HY et al (2020) Pearls for interpreting neurosurgical systematic reviews and Meta-analyses: lessons from a collaborative effort. Neurosurgery. https://doi.org/10.1093/neuros/nyaa027

    Article  PubMed  Google Scholar 

  8. Freeman MF, Tukey JW (1950) Transformations related to the angular and the Square Root. Ann Math Statist 21(4):607–611. https://doi.org/10.1214/aoms/1177729756

    Article  Google Scholar 

  9. DerSimonian R, Laird N (1986) Meta-analysis in clinical trials. Control Clin Trials 7(3):177–188

    Article  CAS  PubMed  Google Scholar 

  10. Higgins JPT, Thompson SG, Deeks JJ, Altman DG (2003) Measuring inconsistency in meta-analyses. BMJ: Br Med J 327(7414):557–560

    Article  Google Scholar 

  11. Begg CB, Mazumdar M (1994) Operating characteristics of a rank correlation test for publication bias. Biometrics 50(4):1088–1101

    Article  CAS  PubMed  Google Scholar 

  12. Egger M, Davey Smith G, Schneider M, Minder C (1997) Bias in meta-analysis detected by a simple, graphical test. BMJ (Clinical Research ed) 315(7109):629–634

    Article  CAS  PubMed  Google Scholar 

  13. Duval S, Tweedie R (2000) Trim and fill: a simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis. Biometrics 56(2):455–463

    Article  CAS  PubMed  Google Scholar 

  14. Atkins D, Best D, Briss PA, Eccles M, Falck-Ytter Y, Flottorp S et al (2004) Grading quality of evidence and strength of recommendations. BMJ (Clinical Research ed) 328(7454):1490. https://doi.org/10.1136/bmj.328.7454.1490

    Article  PubMed  Google Scholar 

  15. Hönikl LS, Lange N, Barz M, Negwer C, Meyer B, Gempt J et al (2022) Postoperative communicating hydrocephalus following glioblastoma resection: incidence, timing and risk factors. Front Oncol 12:953784. https://doi.org/10.3389/fonc.2022.953784

    Article  PubMed  PubMed Central  Google Scholar 

  16. Hong B, Polemikos M, Heissler HE, Hartmann C, Nakamura M, Krauss JK (2018) Challenges in cerebrospinal fluid shunting in patients with glioblastoma. Fluids Barriers CNS 15(1):16. https://doi.org/10.1186/s12987-018-0101-x

    Article  PubMed  PubMed Central  Google Scholar 

  17. Beez T, Burgula S, Kamp M, Rapp M, Steiger H-J, Sabel M (2018) Symptomatic communicating hydrocephalus in a contemporary cohort of high grade glioma patients. Br J Neurosurg 32(1):68–72. https://doi.org/10.1080/02688697.2017.1380780

    Article  PubMed  Google Scholar 

  18. Behling F, Kaltenstadler M, Noell S, Schittenhelm J, Bender B, Eckert F et al (2017) The prognostic impact of ventricular opening in glioblastoma Surgery: a retrospective single Center Analysis. World Neurosurg 106:615–624. https://doi.org/10.1016/j.wneu.2017.07.034

    Article  PubMed  Google Scholar 

  19. Castro BA, Imber BS, Chen R, McDermott MW, Aghi MK (2017) Ventriculoperitoneal Shunting for Glioblastoma: risk factors, indications, and Efficacy. Neurosurgery 80(3):421–430. https://doi.org/10.1227/neu.0000000000001263

    Article  PubMed  PubMed Central  Google Scholar 

  20. Fischer CM, Neidert MC, Péus D, Ulrich NH, Regli L, Krayenbühl N et al (2014) Hydrocephalus after resection and adjuvant radiochemotherapy in patients with glioblastoma. Clin Neurol Neurosurg 120:27–31. https://doi.org/10.1016/j.clineuro.2014.02.012

    Article  PubMed  Google Scholar 

  21. Onuma K, Ishikawa E, Matsuda M, Hirata K, Osuka S, Yamamoto T et al (2013) Clinical characteristics and neuroimaging findings in 12 cases of recurrent glioblastoma with communicating hydrocephalus. Neurol Med Chir (Tokyo) 53(7):474–481. https://doi.org/10.2176/nmc.53.474

    Article  PubMed  Google Scholar 

  22. Montano N, D’Alessandris QG, Bianchi F, Lauretti L, Doglietto F, Fernandez E et al (2011) Communicating hydrocephalus following Surgery and adjuvant radiochemotherapy for glioblastoma. J Neurosurg 115(6):1126–1130. https://doi.org/10.3171/2011.8.Jns11738

    Article  PubMed  Google Scholar 

  23. Roth J, Constantini S, Blumenthal DT, Ram Z (2008) The value of ventriculo-peritoneal shunting in patients with Glioblastoma Multiforme and ventriculomegaly. Acta Neurochir (Wien) 150(1):41–46 discussion 6–7. https://doi.org/10.1007/s00701-007-1454-0

    Article  CAS  PubMed  Google Scholar 

  24. Marquardt G, Setzer M, Lang J, Seifert V (2002) Delayed hydrocephalus after resection of supratentorial malignant gliomas. Acta Neurochir (Wien) 144(3):227–231 discussion 31. https://doi.org/10.1007/s007010200030

    Article  CAS  PubMed  Google Scholar 

  25. Hönikl LS, Lange N, Meyer B, Gempt J, Meyer HS (2023) Postoperative communicating Hydrocephalus following Grade 2/3 Glioma Resection: incidence, timing and risk factors. Cancers (Basel) 15(14). https://doi.org/10.3390/cancers15143548

  26. Burkhardt JK, Zinn PO, Graenicher M, Santillan A, Bozinov O, Kasper EM et al (2011) Predicting postoperative hydrocephalus in 227 patients with skull base meningioma. Neurosurg Focus 30(5):E9. https://doi.org/10.3171/2011.3.Focus117

    Article  PubMed  Google Scholar 

  27. Sharma M, Ambekar S, Sonig A, Nanda A (2013) Factors predicting the development of new onset post-operative hydrocephalus following trans-sphenoidal Surgery for pituitary adenoma. Clin Neurol Neurosurg 115(10):1951–1954. https://doi.org/10.1016/j.clineuro.2013.05.020

    Article  PubMed  Google Scholar 

  28. Picart T, Dumot C, Meyronet D, Pallud J, Metellus P, Zouaoui S et al (2022) Characteristics and management of hydrocephalus in adult patients with cerebellar glioblastoma: lessons from a French nationwide series of 118 cases. Neurosurg Rev 45(1):683–699. https://doi.org/10.1007/s10143-021-01578-2

    Article  PubMed  Google Scholar 

  29. Toma AK, Papadopoulos MC, Stapleton S, Kitchen ND, Watkins LD (2013) Systematic review of the outcome of shunt Surgery in idiopathic normal-pressure hydrocephalus. Acta Neurochir (Wien) 155(10):1977–1980. https://doi.org/10.1007/s00701-013-1835-5

    Article  PubMed  Google Scholar 

  30. Paisan GM, Ding D, Starke RM, Crowley RW, Liu KC (2018) Shunt-Dependent Hydrocephalus after Aneurysmal Subarachnoid Hemorrhage: predictors and long-term functional outcomes. Neurosurgery 83(3):393–402. https://doi.org/10.1093/neuros/nyx393

    Article  PubMed  Google Scholar 

  31. Mansoor N, Solheim O, Fredriksli OA, Gulati S (2021) Revision and complication rates in adult shunt Surgery: a single-institution study. Acta Neurochir (Wien) 163(2):447–454. https://doi.org/10.1007/s00701-020-04526-z

    Article  PubMed  Google Scholar 

  32. Reddy GK, Bollam P, Caldito G (2014) Long-term outcomes of ventriculoperitoneal shunt Surgery in patients with hydrocephalus. World Neurosurg 81(2):404–410. https://doi.org/10.1016/j.wneu.2013.01.096

    Article  PubMed  Google Scholar 

  33. Hosainey SAM, Hald JK, Meling TR (2022) Risk of early failure of VP shunts implanted for hydrocephalus after craniotomies for brain tumors in adults. Neurosurg Rev 45(1):479–490. https://doi.org/10.1007/s10143-021-01549-7

    Article  PubMed  Google Scholar 

  34. Nyberg-Hansen R, Torvik A, Bhatia R (1975) On the pathology of experimental hydrocephalus. Brain Res 95(2–3):343–350. https://doi.org/10.1016/0006-8993(75)90111-0

    Article  CAS  PubMed  Google Scholar 

  35. Mistry AM, Kelly PD, Gallant JN, Mummareddy N, Mobley BC, Thompson RC et al (2019) Comparative Analysis of Subventricular Zone Glioblastoma Contact and Ventricular Entry during Resection in Predicting Dissemination, Hydrocephalus, and Survival. Clin Neurosurg 85(5):E924–E32. https://doi.org/10.1093/neuros/nyz144

    Article  Google Scholar 

  36. Lu VM, Abou-Al-Shaar H, Bin-Alamer O, Luther EM, Benjamin CG (2023) Postoperative course of cerebrospinal fluid diversion in the setting of leptomeningeal Disease: a systematic review, meta-analysis, and meta-regression with an illustrative case. J Neurooncol 163(1):29–37. https://doi.org/10.1007/s11060-023-04334-2

    Article  PubMed  Google Scholar 

  37. Hana T, Tanaka S, Shin M, Mukasa A, Kugasawa K, Saito N (2015) Neuroendoscopic Ventriculocisternostomy with Stent Placement for Trapped Temporal Horn After the Resection of Glioblastoma. World Neurosurg. ;84(6):2078.e5-8. https://doi.org/10.1016/j.wneu.2015.08.019

  38. Garcia-Bonilla M, Castaneyra-Ruiz L, Zwick S, Talcott M, Otun A, Isaacs AM et al (2022) Acquired hydrocephalus is associated with neuroinflammation, progenitor loss, and cellular changes in the subventricular zone and periventricular white matter. Fluids Barriers CNS 19(1):17. https://doi.org/10.1186/s12987-022-00313-3

    Article  CAS  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Department of Neurological Surgery, University of Miami, Jackson Memorial Hospital, Miami, FL, USA

    Victor M. Lu, Adham M. Khalafallah, Emade Jaman, Muhammet Enes Gurses, Ricardo J. Komotar, Michael E. Ivan & Ashish H. Shah

  2. Department of Neurological Surgery, University of Miami Miller School of Medicine, 1095 NW 14th Terrace, 33136, Miami, FL, USA

    Victor M. Lu

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Contributions

Victor M. Lu: Conceptualization, Data curation, Software, Visualization.Muhammet Enes Gurses: Data curation. All authors: Writing- Original draft preparation, Methodology, Investigation, Writing- Reviewing and Editing.

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Correspondence to Victor M. Lu.

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Lu, V.M., Khalafallah, A., Jaman, E. et al. Clinical course of ventriculoperitoneal shunting for hydrocephalus following glioblastoma surgery: a systematic review and meta-analysis. J Neurooncol 165, 439–447 (2023). https://doi.org/10.1007/s11060-023-04538-6

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