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Predictive factors associated with ventriculoperitoneal shunting after posterior fossa tumor surgery in children

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Abstract

Purpose

The aim of the study was to evaluate established risk factors and define new inflammation-associated factors associated with postoperative ventriculoperitoneal shunt placement.

Methods

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.

Results

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.

Conclusions

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.

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References

  1. Ahmann PA, Lazzara A, Dykes FD, Brann AW Jr, Schwartz JF (1980) Intraventricular hemorrhage in the high-risk preterm infant: incidence and outcome. Ann Neurol 7:118–124. https://doi.org/10.1002/ana.410070205

    Article  CAS  PubMed  Google Scholar 

  2. Bhatia R, Tahir M, Chandler CL (2009) The management of hydrocephalus in children with posterior fossa tumours: the role of pre-resectional endoscopic third ventriculostomy. Pediatr Neurosurg 45:186–191. https://doi.org/10.1159/000222668

    Article  PubMed  Google Scholar 

  3. Bognar L, Borgulya G, Benke P, Madarassy G (2003) Analysis of CSF shunting procedure requirement in children with posterior fossa tumors. Childs Nerv Syst 19:332–336. https://doi.org/10.1007/s00381-003-0745-x

    Article  PubMed  Google Scholar 

  4. Chaplin ER, Goldstein GW, Myerberg DZ, Hunt JV, Tooley WH (1980) Posthemorrhagic hydrocephalus in the preterm infant. Pediatrics 65:901–909

    CAS  PubMed  Google 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

  6. Chen Q, Feng Z, Tan Q, Guo J, Tang J, Tan L, Feng H, Chen Z (2017) Post-hemorrhagic hydrocephalus: recent advances and new therapeutic insights. J Neurol Sci 375:220–230. https://doi.org/10.1016/j.jns.2017.01.072

    Article  PubMed  Google Scholar 

  7. Culley DJ, Berger MS, Shaw D, Geyer R (1994) An analysis of factors determining the need for ventriculoperitoneal shunts after posterior fossa tumor surgery in children. Neurosurgery 34:402–407 discussion 407-408

    Article  CAS  PubMed  Google Scholar 

  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

    Article  PubMed  Google 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

    Article  Google 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):15–19

    Google Scholar 

  11. Dias MS, Albright AL (1989) Management of hydrocephalus complicating childhood posterior fossa tumors. Pediatr Neurosci 15:283–289; discussion 290

    Article  CAS  PubMed  Google Scholar 

  12. Due-Tonnessen BJ, Helseth E (2007) Management of hydrocephalus in children with posterior fossa tumors: role of tumor surgery. Pediatr Neurosurg 43:92–96. https://doi.org/10.1159/000098379

    Article  PubMed  Google Scholar 

  13. El Beltagy MA, Kamal HM, Taha H, Awad M, El Khateeb N (2010) Endoscopic third ventriculostomy before tumor surgery in children with posterior fossa tumors, CCHE experience. Childs Nerv Syst 26:1699–1704

    Article  PubMed  Google 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

    Article  PubMed  Google Scholar 

  15. Gopalakrishnan CV, Dhakoji A, Menon G, Nair S (2012) Factors predicting the need for cerebrospinal fluid diversion following posterior fossa tumor surgery in children. Pediatr Neurosurg 48:93–101. https://doi.org/10.1159/000343009

    Article  CAS  PubMed  Google 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

    Article  CAS  PubMed  PubMed Central  Google 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

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Juvela S, Kuhmonen J, Siironen J (2012) C-reactive protein as predictor for poor outcome after aneurysmal subarachnoid haemorrhage. Acta Neurochir 154:397–404. https://doi.org/10.1007/s00701-011-1243-7

    Article  PubMed  Google 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

    Article  CAS  PubMed  Google 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

    Article  PubMed  PubMed Central  Google 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

    Article  CAS  PubMed  Google 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

    Article  PubMed  Google 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

    Article  PubMed  Google Scholar 

  24. Kumar V, Phipps K, Harkness W, Hayward RD (1996) Ventriculo-peritoneal shunt requirement in children with posterior fossa tumours: an 11-year audit. Br J Neurosurg 10:467–470

    Article  CAS  PubMed  Google Scholar 

  25. Lee M, Wisoff JH, Abbott R, Freed D, Epstein FJ (1994) Management of hydrocephalus in children with medulloblastoma: prognostic factors for shunting. Pediatr Neurosurg 20:240–247. https://doi.org/10.1159/000120797

    Article  CAS  PubMed  Google Scholar 

  26. Merchant TE, Fouladi M (2005) Ependymoma: new therapeutic approaches including radiation and chemotherapy. J Neuro-Oncol 75:287–299. https://doi.org/10.1007/s11060-005-6753-9

    Article  Google 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

    Article  PubMed  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

    Article  PubMed  Google Scholar 

  29. O’Hayon BB, Drake JM, Ossip MG, Tuli S, Clarke M (1998) Frontal and occipital horn ratio: a linear estimate of ventricular size for multiple imaging modalities in pediatric hydrocephalus. Pediatr Neurosurg 29:245–249 doi:28730

    Article  Google Scholar 

  30. Papo I, Caruselli G, Luongo A (1982) External ventricular drainage in the management of posterior fossa tumors in children and adolescents. Neurosurgery 10:13–15

    CAS  PubMed  Google Scholar 

  31. Rekate HL (2008) Shunt-related headaches: the slit ventricle syndromes. Childs Nerv Syst 24:423–430. https://doi.org/10.1007/s00381-008-0579-7

    Article  PubMed  Google Scholar 

  32. Riva-Cambrin J, Detsky AS, Lamberti-Pasculli M, Sargent MA, Armstrong D, Moineddin R, Cochrane DD, Drake JM (2009) Predicting postresection hydrocephalus in pediatric patients with posterior fossa tumors. J Neurosurg Pediatr 3:378–385. https://doi.org/10.3171/2009.1.PEDS08298

    Article  PubMed  Google Scholar 

  33. Ruggiero C, Cinalli G, Spennato P, Aliberti F, Cianciulli E, Trischitta V, Maggi G (2004) Endoscopic third ventriculostomy in the treatment of hydrocephalus in posterior fossa tumors in children. Childs Nerv Syst 20:828–833. https://doi.org/10.1007/s00381-004-0938-y

    Article  PubMed  Google 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 95:791–797

    Article  CAS  PubMed  Google 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

    Article  PubMed  Google Scholar 

  36. Savman K, Blennow M, Hagberg H, Tarkowski E, Thoresen M, Whitelaw A (2002) Cytokine response in cerebrospinal fluid from preterm infants with posthaemorrhagic ventricular dilatation. Acta Paediatr 91:1357–1363

    Article  CAS  PubMed  Google Scholar 

  37. Schmid UD, Seiler RW (1986) Management of obstructive hydrocephalus secondary to posterior fossa tumors by steroids and subcutaneous ventricular catheter reservoir. J Neurosurg 65:649–653. https://doi.org/10.3171/jns.1986.65.5.0649

    Article  CAS  PubMed  Google Scholar 

  38. Schneider C, Ramaswamy V, Kulkarni AV, Rutka JT, Remke M, Tabori U, Hawkins C, Bouffet E, Taylor MD (2015) Clinical implications of medulloblastoma subgroups: incidence of CSF diversion surgery. J Neurosurg Pediatr 15:236–242. https://doi.org/10.3171/2014.9.PEDS14280

    Article  PubMed  Google 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

    Article  CAS  PubMed  Google Scholar 

  40. Wang L, Gao Z (2018) Expression of MMP-9 and IL-6 in patients with subarachnoid hemorrhage and the clinical significance. Exp Ther Med 15:1510–1514. https://doi.org/10.3892/etm.2017.5553

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany

    Leonie Johanna Helmbold, Gertrud Kammler, Jan Regelsberger, Friederike Sophie Fritzsche, Pedram Emami & Kara Krajewski

  2. Department of Neuropathology and Department of Hematology and Oncology, Research Institute Children’s Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany

    Ulrich Schüller

  3. Department of Neurosurgery, University Medical Center Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany

    Kara Krajewski

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  1. Leonie Johanna Helmbold
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Helmbold, L.J., Kammler, G., Regelsberger, J. et al. Predictive factors associated with ventriculoperitoneal shunting after posterior fossa tumor surgery in children. Childs Nerv Syst 35, 779–788 (2019). https://doi.org/10.1007/s00381-019-04136-w

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