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Postoperative intraventricular blood: a new modifiable risk factor for early postoperative symptomatic hydrocephalus in children with posterior fossa tumors

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Abstract

Objective

To analyze factors associated with the development of early symptomatic hydrocephalus following posterior fossa tumor (PFT) surgery in children.

Methods

In this retrospective study, data from 148 children (age < 18 years) who underwent primary resection of their PFTs without preoperative permanent CSF diversion procedures were collected. The incidence of symptomatic hydrocephalus within 30 days of tumor resection was studied and its association with various demographic, tumor-related, and surgery-related risk factors was analyzed.

Results

At presentation, 131 (89%) of the 148 patients had symptomatic hydrocephalus. There were 99 males and 49 females (mean age 8.7 years; range 1 to 17 years). Postoperatively, 14 (9.4%) patients required shunt placement for symptomatic hydrocephalus. The indications for shunt surgery were persistent symptoms of raised intracranial pressure (n = 6, 43%), CSF leak from the wound (n = 7, 50%), and tense pseudomeningocele (n = 1, 7%). On multivariate analysis, age < 6 years (OR 5.9, 95% CI 1.6–22.6, p = 0.009) and the presence of intraventricular blood (IVB) on postoperative CT (OR 6.4, 95% CI 1.7–23.7, p = 0.006) were independent risk factors for developing symptomatic hydrocephalus.

Conclusions

The incidence of postoperative symptomatic hydrocephalus in our series (9.4%) is lower than that reported in most previous studies. Age < 6 years and the presence of postoperative IVB were independent risk factors for developing symptomatic hydrocephalus. Of these, postoperative IVB is probably the only modifiable risk factor.

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Authors and Affiliations

  1. Department of Neurological Sciences, Christian Medical College, Vellore, Tamil Nadu, India

    Ananth P. Abraham, Ranjith K. Moorthy, Lakshmanan Jeyaseelan & Vedantam Rajshekhar

  2. Department of Biostatistics, Christian Medical College, Vellore, Tamil Nadu, India

    Lakshmanan Jeyaseelan

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  1. Ananth P. Abraham
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Correspondence to Vedantam Rajshekhar.

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The authors report no conflict of interest. The datasets generated for the study are available from the corresponding author on reasonable request.

Additional information

A portion of this study was presented as a podium presentation at the 29th Annual Conference of the Indian Society for Pediatric Neurosurgery in February, 2018.

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Abraham, A.P., Moorthy, R.K., Jeyaseelan, L. et al. Postoperative intraventricular blood: a new modifiable risk factor for early postoperative symptomatic hydrocephalus in children with posterior fossa tumors. Childs Nerv Syst 35, 1137–1146 (2019). https://doi.org/10.1007/s00381-019-04195-z

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