Predictive factors associated with ventriculoperitoneal shunting after posterior fossa tumor surgery in children
- 35 Downloads
The aim of the study was to evaluate established risk factors and define new inflammation-associated factors associated with postoperative ventriculoperitoneal shunt placement.
The electronic medical records of children who underwent surgery for a tumor in the posterior fossa between January 2009 and January 2018 were retrospectively analyzed. Factors evaluated include age, clinical symptoms, tumor type, extent of surgical tumor resection, treatment with EVD and/or ETV, radiological findings, postoperative serum CRP, and leucocyte levels. Tumor tissue was stained immunohistochemically with antibodies against CD3, and leucocyte counts were performed. Patients with pre- or postoperative signs of infection or confirmation of a concurrent infection were excluded from some analyses.
Seventy patients ages 0.4–20.8 years (median, 8.2) were included. Forty-five of 70 (65.3%) presented postoperative radiological signs of hydrocephalus. Fifteen of 70 (21.4%) patients required shunt placement postoperatively. Shunt placement was significantly associated with age < 3 years at diagnosis (p = 0.013), perioperative EVD placement (p < 0.001), signs of hydrocephalus in postoperative imaging (p = 0.047), a frontooccipital horn ratio (FOHR) > 0.46 within the first 72 h postoperatively (p < 0.001), and the presence of intraventricular blood postoperatively (p = 0.007). Six patients who underwent shunting had serum CRP levels > 40 mg/l (p = 0.030) within the first 48 h postoperatively. Tumor type or extent of resection did not correlate with shunt placement.
Several established and new factors associated with shunt placement after posterior fossa tumor surgery could be identified. Additional studies are needed to explore the aseptic inflammation pathways involved with increased CRP levels and shunt placement.
KeywordsInflammation markers CRP Intraventricular blood Hydrocephalus
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
- 4.Chaplin ER, Goldstein GW, Myerberg DZ, Hunt JV, Tooley WH (1980) Posthemorrhagic hydrocephalus in the preterm infant. Pediatrics 65:901–909Google Scholar
- 5.Chaudhry SR, Stoffel-Wagner B, Kinfe TM, Guresir E, Vatter H, Dietrich D, Lamprecht A, Muhammad S (2017) Elevated systemic IL-6 levels in patients with aneurysmal subarachnoid hemorrhage is an unspecific marker for post-SAH complications. Int J Mol Sci 18. https://doi.org/10.3390/ijms18122580
- 8.de Ribaupierre S, Rilliet B, Vernet O, Regli L, Villemure JG (2007) Third ventriculostomy vs ventriculoperitoneal shunt in pediatric obstructive hydrocephalus: results from a Swiss series and literature review. Childs Nerv Syst 23:527–533. https://doi.org/10.1007/s00381-006-0283-4 CrossRefGoogle Scholar
- 9.Dewan MC, Lim J, Shannon CN, Wellons JC 3rd (2017) The durability of endoscopic third ventriculostomy and ventriculoperitoneal shunts in children with hydrocephalus following posterior fossa tumor resection: a systematic review and time-to-failure analysis. J Neurosurg Pediatr 19:1–7. https://doi.org/10.3171/2017.1.peds16536 CrossRefGoogle Scholar
- 10.Di Rocco F, Jucá CE, Zerah M, Sainte-Rose C (2013) Endoscopic third ventriculostomy and posterior fossa tumors. World Neurosurg 79(2 Suppl):15–19Google Scholar
- 14.Foreman P, Mc-Clugage S 3rd, Naftel R, Griessenauer CJ, Ditty BJ, Agee BS, Riva-Cambrin J, Wellons J 3rd (2013) Validation and modification of a predictive model of postresection hydrocephalus in pediatric patients with posterior fossa tumors. J Neurosurg Pediatr 12:220–226. https://doi.org/10.3171/2013.5.peds1371 CrossRefGoogle Scholar
- 16.Gram M, Sveinsdottir S, Cinthio M, Sveinsdottir K, Hansson SR, Morgelin M, Akerstrom B, Ley D (2014) Extracellular hemoglobin - mediator of inflammation and cell death in the choroid plexus following preterm intraventricular hemorrhage. J Neuroinflammation 11:200. https://doi.org/10.1186/s12974-014-0200-9 CrossRefGoogle Scholar
- 17.Habiyaremye G, Morales DM, Morgan CD, McAllister JP, CreveCoeur TS, Han RH, Gabir M, Baksh B, Mercer D, Limbrick DD Jr (2017) Chemokine and cytokine levels in the lumbar cerebrospinal fluid of preterm infants with post-hemorrhagic hydrocephalus. Fluids Barriers CNS 14:35. https://doi.org/10.1186/s12987-017-0083-0 CrossRefGoogle Scholar
- 19.Karimy JK, Zhang J, Kurland DB, Theriault BC, Duran D, Stokum JA, Furey CG, Zhou X, Mansuri MS, Montejo J, Vera A, DiLuna ML, Delpire E, Alper SL, Gunel M, Gerzanich V, Medzhitov R, Simard JM, Kahle KT (2017) Inflammation-dependent cerebrospinal fluid hypersecretion by the choroid plexus epithelium in posthemorrhagic hydrocephalus. Nat Med 23:997–1003. https://doi.org/10.1038/nm.4361 CrossRefGoogle Scholar
- 20.Kestle JR, Riva-Cambrin J, Wellons JC 3rd, Kulkarni AV, Whitehead WE, Walker ML, Oakes WJ, Drake JM, Luerssen TG, Simon TD, Holubkov R, Hydrocephalus Clinical Research N (2011) A standardized protocol to reduce cerebrospinal fluid shunt infection: the Hydrocephalus Clinical Research Network Quality Improvement Initiative. J Neurosurg Pediatr 8:22–29. https://doi.org/10.3171/2011.4.PEDS10551 CrossRefGoogle Scholar
- 21.Killer M, Arthur A, Al-Schameri AR, Barr J, Elbert D, Ladurner G, Shum J, Cruise G (2010) Cytokine and growth factor concentration in cerebrospinal fluid from patients with hydrocephalus following endovascular embolization of unruptured aneurysms in comparison with other types of hydrocephalus. Neurochem Res 35:1652–1658. https://doi.org/10.1007/s11064-010-0226-z CrossRefGoogle Scholar
- 22.Kulkarni AV, Riva-Cambrin J, Butler J, Browd SR, Drake JM, Holubkov R, Kestle JR, Limbrick DD, Simon TD, Tamber MS, Wellons JC 3rd, Whitehead WE, Hydrocephalus Clinical Research N (2013) Outcomes of CSF shunting in children: comparison of Hydrocephalus Clinical Research Network cohort with historical controls. clinical article J Neurosurg Pediatr 12:334–338. https://doi.org/10.3171/2013.7.PEDS12637 CrossRefGoogle Scholar
- 23.Kulkarni AV, Riva-Cambrin J, Holubkov R, Browd SR, Cochrane DD, Drake JM, Limbrick DD, Rozzelle CJ, Simon TD, Tamber MS, Wellons JC 3rd, Whitehead WE, Kestle JR (2016) Endoscopic third ventriculostomy in children: prospective, multicenter results from the Hydrocephalus Clinical Research Network. J Neurosurg Pediatr 18:423–429. https://doi.org/10.3171/2016.4.peds163 CrossRefGoogle Scholar
- 27.Morelli D, Pirotte B, Lubansu A, Detemmerman D, Aeby A, Fricx C, Berre J, David P, Brotchi J (2005) Persistent hydrocephalus after early surgical management of posterior fossa tumors in children: is routine preoperative endoscopic third ventriculostomy justified? J Neurosurg 103:247–252. https://doi.org/10.3171/ped.2005.103.3.0247 Google Scholar
- 28.Naureen I, Waheed Kh A, Rathore AW, Victor S, Mallucci C, Goodden JR, Chohan SN, Miyan JA (2014) Fingerprint changes in CSF composition associated with different aetiologies in human neonatal hydrocephalus: inflammatory cytokines. Childs Nerv Syst 30:1155–1164. https://doi.org/10.1007/s00381-014-2415-6 CrossRefGoogle Scholar
- 30.Papo I, Caruselli G, Luongo A (1982) External ventricular drainage in the management of posterior fossa tumors in children and adolescents. Neurosurgery 10:13–15Google Scholar
- 34.Sainte-Rose C, Cinalli G, Roux FE, Maixner R, Chumas PD, Mansour M, Carpentier A, Bourgeois M, Zerah M, Pierre-Kahn A, Renier D (2001) Management of hydrocephalus in pediatric patients with posterior fossa tumors: the role of endoscopic third ventriculostomy. J Neurosurg 95:791–797CrossRefGoogle Scholar
- 35.Santos de Oliveira R, Barros Juca CE, Valera ET, Machado HR (2008) Hydrocephalus in posterior fossa tumors in children. Are there factors that determine a need for permanent cerebrospinal fluid diversion? Childs Nerv Syst 24:1397–1403. https://doi.org/10.1007/s00381-008-0649-x CrossRefGoogle Scholar
- 39.Tamburrini G, Pettorini BL, Massimi L, Caldarelli M, Di Rocco C (2008) Endoscopic third ventriculostomy: the best option in the treatment of persistent hydrocephalus after posterior cranial fossa tumour removal? Childs Nerv Syst 24:1405–1412. https://doi.org/10.1007/s00381-008-0699-0 CrossRefGoogle Scholar