Management of Hydrocephalus Secondary to Posterior Fossa Tumor in Childhood
A series of 112 children with cerebellum — fourth ventricle tumors treated surgically from 1980 through 1989 is presented. Pathology of these tumors consists of 52 medulloblastomas, 46 astrocytomas, and 14 ependymomas. All patients had a radical tumor resection, and patients with insufficient tumor resection or with other tumor histology are not included in this study. Neuroimaging studies showed hydrocephalus in all but 10 patients. For the management of associated hydrocephalus, a precraniotomy shunt was placed in 38 patients; 5 of them were complicated by upward herniation or intratumoral hemorrhage. After radical resection of the tumor, the precraniotomy shunt was successfully removed in 14 patients (36.8%). The remaining patients had posterior fossa craniotomy without shunt: 46 had intraoperative ventriculostomy and postoperative external ventricular drainage (EVD) and intracranial pressure (ICP) monitoring, while 20 had no postoperative EVD. Of 66 patients without precraniotomy shunts, 13 (20%) needed a permanent shunt after tumor resection. Hydrocephalus associated with a resectable posterior fossa tumor is best managed by intraoperative ventriculostomy and postoperative EVD and ICP monitoring, which provide a smooth postoperative course and avoid multiple surgical procedures and shunt-dependency.
KeywordsHydrocephalus CSF shunt Cerebellar neoplasms Intracranial pressure monitor Upward herniation
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