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Hydrocephalus Related to CNS Malignancies in Adults

  • Emilie Le RhunEmail author
  • Jörg-Christian Tonn
  • Michael Weller
Chapter

Abstract

Central nervous system tumors represent a main cause of hydrocephalus which, in the overall course of disease, can be observed in approximately 5–10% of patients with glioblastoma and 6–24% of patients with central nervous system metastases. The incidence may be higher, up to 23%, in the adult population with fossa posterior tumors. Obstructive hydrocephalus is related to a mechanical block of CSF flow, whereas communicative hydrocephalus is related to an imbalance between CSF production and outflow. Several options are available for the management of hydrocephalus, depending on its cause and on the neurological condition of the patient: direct surgical removal of the responsible lesion or endoscopic third ventriculostomy (ETV) for obstructive hydrocephalus, ventriculoperitoneal (VPS) or ventriculoatrial (VA) shunt for communicative hydrocephalus, and external ventricular drainage (EVD) as a transient emergency measure. Obstructive hydrocephalus may result in peracute potentially fatal deterioration and thus may require an emergency procedure after diagnosis. Symptomatic pharmacological treatments such as steroids or analgesics usually have limited efficacy in patients with hydrocephalus. Rapid clinical improvement with improvement of the quality of life and sometimes the possibility to administer further oncologic treatment can often be achieved after a timely CSF diversion.

Keywords

Obstructive Communicative Cerebrospinal Leptomeningeal Metastases Pressure Ventriculostomy Ventriculoperitoneal Shunt Drain 

References

  1. 1.
    Lam S, Harris DA, Lin Y, Rocque BG, Ham S, Pan I-W (2016) Outcomes of endoscopic third ventriculostomy in adults. J Clin Neurosci 31:166–171CrossRefGoogle Scholar
  2. 2.
    Perrini P, Scollato A, Cioffi F, Mouchaty H, Conti R, Di Lorenzo N (2002) Radiation leukoencephalopathy associated with moderate hydrocephalus: intracranial pressure monitoring and results of ventriculoperitoneal shunting. Neurol Sci 23(5):237–241CrossRefGoogle Scholar
  3. 3.
    Madsen PJ, Mallela AN, Hudgins ED, Storm PB, Heuer GG, Stein SC (2018) The effect and evolution of patient selection on outcomes in endoscopic third ventriculostomy for hydrocephalus: a large-scale review of the literature. J Neurol Sci 385:185–191CrossRefGoogle Scholar
  4. 4.
    Castro BA, Imber BS, Chen R, McDermott MW, Aghi MK (2017) Ventriculoperitoneal shunting for glioblastoma: risk factors, indications, and efficacy. Neurosurgery 80(3):421–430PubMedPubMedCentralGoogle Scholar
  5. 5.
    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):9–15CrossRefGoogle Scholar
  6. 6.
    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):1126–1130CrossRefGoogle Scholar
  7. 7.
    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 120:27–31CrossRefGoogle Scholar
  8. 8.
    Omuro AMP, Lallana EC, Bilsky MH, DeAngelis LM (2005) Ventriculoperitoneal shunt in patients with leptomeningeal metastasis. Neurology 64(9):1625–1627CrossRefGoogle Scholar
  9. 9.
    Niwińska A, Rudnicka H, Murawska M (2013) Breast cancer leptomeningeal metastasis: propensity of breast cancer subtypes for leptomeninges and the analysis of factors influencing survival. Med Oncol 30(1):408CrossRefGoogle Scholar
  10. 10.
    Lee SJ, Lee J-I, Nam D-H, Ahn YC, Han JH, Sun J-M et al (2013) Leptomeningeal carcinomatosis in non-small-cell lung cancer patients: impact on survival and correlated prognostic factors. J Thorac Oncol 8(2):185–191CrossRefGoogle Scholar
  11. 11.
    Sunderland GJ, Jenkinson MD, Zakaria R (2016) Surgical management of posterior fossa metastases. J Neuro-Oncol 130(3):535–542CrossRefGoogle Scholar
  12. 12.
    Ghods AJ, Munoz L, Byrne R (2011) Surgical treatment of cerebellar metastases. Surg Neurol Int 2:159CrossRefGoogle Scholar
  13. 13.
    Marx S, Reinfelder M, Matthes M, Schroeder HWS, Baldauf J (2018) Frequency and treatment of hydrocephalus prior to and after posterior fossa tumor surgery in adult patients. Acta Neurochir 160(5):1063–1071CrossRefGoogle Scholar
  14. 14.
    Nigim F, Critchlow JF, Kasper EM (2015) Role of ventriculoperitoneal shunting in patients with neoplasms of the central nervous system: an analysis of 59 cases. Mol Clin Oncol 3(6):1381–1386CrossRefGoogle Scholar
  15. 15.
    Relkin N, Marmarou A, Klinge P, Bergsneider M, Black PM (2005) Diagnosing idiopathic normal-pressure hydrocephalus. Neurosurgery 57(Suppl 3):S4–S16; discussion ii–vPubMedGoogle Scholar
  16. 16.
    Toma AK, Holl E, Kitchen ND, Watkins LD (2011) Evans’ index revisited: the need for an alternative in normal pressure hydrocephalus. Neurosurgery 68(4):939–944CrossRefGoogle Scholar
  17. 17.
    Di Rocco F, Jucá CE, Zerah M, Sainte-Rose C (2013) Endoscopic third ventriculostomy and posterior fossa tumors. World Neurosurg 79(Suppl 2):S18.e15–S18.e19Google Scholar
  18. 18.
    Di Vincenzo J, Keiner D, Gaab MR, Schroeder HWS, Oertel JMK (2014) Endoscopic third ventriculostomy: preoperative considerations and intraoperative strategy based on 300 procedures. J Neurol Surg A Cent Eur Neurosurg 75(1):20–30CrossRefGoogle Scholar
  19. 19.
    Grand W, Leonardo J, Chamczuk AJ, Korus AJ (2016) Endoscopic third ventriculostomy in 250 adults with hydrocephalus: patient selection, outcomes, and complications. Neurosurgery 78(1):109–119CrossRefGoogle Scholar
  20. 20.
    Isaacs AM, Bezchlibnyk YB, Yong H, Koshy D, Urbaneja G, Hader WJ et al (2016) Endoscopic third ventriculostomy for treatment of adult hydrocephalus: long-term follow-up of 163 patients. Neurosurg Focus 41(3):E3CrossRefGoogle Scholar
  21. 21.
    Nguyen TT, Smith MV, Rodziewicz GS, Lemke SM (1999) Hydrocephalus caused by metastatic brain lesions: treatment by third ventriculostomy. J Neurol Neurosurg Psychiatry 67(4):552–553CrossRefGoogle Scholar
  22. 22.
    Marx S, El Damaty A, Manwaring J, El Refaee E, Fleck S, Fritsch M et al (2018) Endoscopic third ventriculostomy before posterior fossa tumor surgery in adult patients. J Neurol Surg A Cent Eur Neurosurg 79(2):123–129CrossRefGoogle Scholar
  23. 23.
    Chen CC, Kasper E, Warnke P (2011) Palliative stereotactic-endoscopic third ventriculostomy for the treatment of obstructive hydrocephalus from cerebral metastasis. Surg Neurol Int 2:76CrossRefGoogle Scholar
  24. 24.
    Gonda DD, Kim TE, Warnke PC, Kasper EM, Carter BS, Chen CC (2012) Ventriculoperitoneal shunting versus endoscopic third ventriculostomy in the treatment of patients with hydrocephalus related to metastasis. Surg Neurol Int 3:97CrossRefGoogle Scholar
  25. 25.
    Jung T-Y, Chung W-K, Oh I-J (2014) The prognostic significance of surgically treated hydrocephalus in leptomeningeal metastases. Clin Neurol Neurosurg 119:80–83CrossRefGoogle Scholar
  26. 26.
    Agarwal N, Kashkoush A, McDowell MM, Lariviere WR, Ismail N, Friedlander RM (2018) Comparative durability and costs analysis of ventricular shunts. J Neurosurg 11:1–8CrossRefGoogle Scholar
  27. 27.
    Anwar R, Sadek A-R, Vajramani G (2017) Abdominal pseudocyst: a rare complication of ventriculoperitoneal shunting. Pract Neurol 17(3):212–213CrossRefGoogle Scholar
  28. 28.
    Hung AL, Vivas-Buitrago T, Adam A, Lu J, Robison J, Elder BD et al (2017) Ventriculoatrial versus ventriculoperitoneal shunt complications in idiopathic normal pressure hydrocephalus. Clin Neurol Neurosurg 157:1–6CrossRefGoogle Scholar
  29. 29.
    Berger-Estilita J, Passer M, Giles M, Wiegand J, Merz TM (2018) Modalities and accuracy of diagnosis of external ventricular drainage-related infections: a prospective multicentre observational cohort study. Acta Neurochir 160(10):2039–2047CrossRefGoogle Scholar
  30. 30.
    Lenski M, Huge V, Schmutzer M, Ueberschaer M, Briegel J, Tonn J-C et al (2018) Inflammatory markers in serum and cerebrospinal fluid for early detection of external ventricular drain-associated ventriculitis in patients with subarachnoid hemorrhage. J Neurosurg AnesthesiolGoogle Scholar
  31. 31.
    Sainte-Rose C, Cinalli G, Roux FE, Maixner R, Chumas PD, Mansour M et al (2001) Management of hydrocephalus in pediatric patients with posterior fossa tumors: the role of endoscopic third ventriculostomy. J Neurosurg 95(5):791–797CrossRefGoogle Scholar
  32. 32.
    Gliemroth J, Käsbeck E, Kehler U (2014) Ventriculocisternostomy versus ventriculoperitoneal shunt in the treatment of hydrocephalus: a retrospective, long-term observational study. Clin Neurol Neurosurg 122:92–96CrossRefGoogle Scholar
  33. 33.
    Lee SH, Kong DS, Seol HJ, Nam D-H, Lee J-I (2011) Ventriculoperitoneal shunt for hydrocephalus caused by central nervous system metastasis. J Neuro-Oncol 104(2):545–551CrossRefGoogle Scholar
  34. 34.
    de Lima BO, Pratesi R (2014) Endoscopic third ventriculostomy has no higher costs than ventriculoperitoneal shunt. Arq Neuropsiquiatr 72(7):524–527CrossRefGoogle Scholar
  35. 35.
    Reddy GK, Bollam P, Caldito G, Willis B, Guthikonda B, Nanda A (2011) Ventriculoperitoneal shunt complications in hydrocephalus patients with intracranial tumors: an analysis of relevant risk factors. J Neuro-Oncol 103(2):333–342CrossRefGoogle Scholar
  36. 36.
    Lin C-T, Riva-Cambrin JK (2015) Management of posterior fossa tumors and hydrocephalus in children: a review. Childs Nerv Syst 31(10):1781–1789CrossRefGoogle Scholar
  37. 37.
    Rinaldo L, Brown D, Lanzino G, Parney IF (2017) Outcomes following cerebrospinal fluid shunting in high-grade glioma patients. J Neurosurg 22:1–13Google Scholar
  38. 38.
    Fukuda M, Takao T, Hiraishi T, Yoshimura J, Yajima N, Saito A et al (2014) Clinical factors predicting outcomes after surgical resection for sporadic cerebellar hemangioblastomas. World Neurosurg 82(5):815–821CrossRefGoogle Scholar
  39. 39.
    Niu L, Zhang Y, Li Q, Dai J, Yin H, Duan L et al (2016) The analysis of correlative factors affecting long-term outcomes in patients with Solid Cerebellar Hemangioblastomas. Clin Neurol Neurosurg 150:59–66CrossRefGoogle Scholar
  40. 40.
    Atlas MD, Perez de Tagle JR, Cook JA, Sheehy JP, Fagan PA (1996) Evolution of the management of hydrocephalus associated with acoustic neuroma. Laryngoscope 106(2 Pt 1):204–206CrossRefGoogle Scholar
  41. 41.
    Pirouzmand F, Tator CH, Rutka J (2001) Management of hydrocephalus associated with vestibular schwannoma and other cerebellopontine angle tumors. Neurosurgery 48(6):1246–1253; discussion 1253–1254PubMedGoogle Scholar
  42. 42.
    Taniguchi M, Nakai T, Kohta M, Kimura H, Kohmura E (2016) Communicating hydrocephalus associated with small- to medium-sized vestibular schwannomas: clinical significance of the tumor apparent diffusion coefficient map. World Neurosurg 94:261–267CrossRefGoogle Scholar
  43. 43.
    Harati A, Scheufler K-M, Schultheiss R, Tonkal A, Harati K, Oni P et al (2017) Clinical features, microsurgical treatment, and outcome of vestibular schwannoma with brainstem compression. Surg Neurol Int 8:45CrossRefGoogle Scholar
  44. 44.
    McClelland S, Kim E, Murphy JD, Jaboin JJ (2017) Operative mortality rates of acoustic neuroma surgery: a national cancer database analysis. Otol Neurotol 38(5):751–753CrossRefGoogle Scholar
  45. 45.
    Bir SC, Sapkota S, Maiti TK, Konar S, Bollam P, Nanda A (2017) Evaluation of ventriculoperitoneal shunt-related complications in intracranial meningioma with hydrocephalus. J Neurol Surg B Skull Base 78(1):30–36CrossRefGoogle Scholar
  46. 46.
    Ghia A, Tomé WA, Thomas S, Cannon G, Khuntia D, Kuo JS et al (2007) Distribution of brain metastases in relation to the hippocampus: implications for neurocognitive functional preservation. Int J Radiat Oncol Biol Phys 68(4):971–977CrossRefGoogle Scholar
  47. 47.
    Suki D, Hatiboglu MA, Patel AJ, Weinberg JS, Groves MD, Mahajan A et al (2009) Comparative risk of leptomeningeal dissemination of cancer after surgery or stereotactic radiosurgery for a single supratentorial solid tumor metastasis. Neurosurgery 64(4):664–674; discussion 674–676CrossRefGoogle Scholar
  48. 48.
    Roux A, Botella C, Still M, Zanello M, Dhermain F, Metellus P et al (2018) Posterior fossa metastasis-associated obstructive hydrocephalus in adult patients: literature review and practical considerations from the Neuro-Oncology Club of the French Society of Neurosurgery. World Neurosurg 117:271–279CrossRefGoogle Scholar
  49. 49.
    Murakami Y, Ichikawa M, Bakhit M, Jinguji S, Sato T, Fujii M et al (2018) Palliative shunt surgery for patients with leptomeningeal metastasis. Clin Neurol Neurosurg 168:175–178CrossRefGoogle Scholar
  50. 50.
    Narayan A, Jallo G, Huisman TAGM (2015) Extracranial, peritoneal seeding of primary malignant brain tumors through ventriculo-peritoneal shunts in children: case report and review of the literature. Neuroradiol J 28(5):536–539CrossRefGoogle Scholar
  51. 51.
    Rickert CH (1998) Abdominal metastases of pediatric brain tumors via ventriculo-peritoneal shunts. Childs Nerv Syst 14(1–2):10–14CrossRefGoogle Scholar
  52. 52.
    Jamjoom ZA, Jamjoom AB, Sulaiman AH, Naim-Ur-Rahman null, al Rabiaa A (1993) Systemic metastasis of medulloblastoma through ventriculoperitoneal shunt: report of a case and critical analysis of the literature. Surg Neurol 40(5):403–410CrossRefGoogle Scholar
  53. 53.
    Zairi F, Le Rhun E, Bertrand N, Boulanger T, Taillibert S, Aboukais R et al (2015) Complications related to the use of an intraventricular access device for the treatment of leptomeningeal metastases from solid tumor: a single centre experience in 112 patients. J Neuro-Oncol 124(2):317–323CrossRefGoogle Scholar
  54. 54.
    Kennedy BC, Brown LT, Komotar RJ, McKhann GM (2016) Stereotactic catheter placement for Ommaya reservoirs. J Clin Neurosci 27:44–47CrossRefGoogle Scholar
  55. 55.
    Morgenstern PF, Connors S, Reiner AS, Greenfield JP (2016) Image guidance for placement of ommaya reservoirs: comparison of fluoroscopy and frameless stereotactic navigation in 145 patients. World Neurosurg 93:154–158CrossRefGoogle Scholar
  56. 56.
    Volkov AA, Filis AK, Vrionis FD (2017) Surgical treatment for leptomeningeal disease. Cancer Control 24(1):47–53CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Emilie Le Rhun
    • 1
    • 2
    • 3
    • 4
    Email author
  • Jörg-Christian Tonn
    • 5
  • Michael Weller
    • 4
  1. 1.Neuro-Oncology Department of NeurosurgeryUniversity Hospital Lille, Salengro HospitalLilleFrance
  2. 2.Neurology Department of Medical OncologyOscar Lambret CenterLilleFrance
  3. 3.Inserm U-1192Villeneuve d’AscqFrance
  4. 4.Department of NeurologyUniversity Hospital and University of ZurichZurichSwitzerland
  5. 5.Department of NeurosurgeryUniversity Hospital Ludwig Maximilian University MunichMunichGermany

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