VP-shunt requirement in patients with posterior fossa tumors

Abstract EN

CSF diversion in posterior fossa tumors has been a dilemma for a long time.

Currently most authors prohibit precrainiotomy shunting based on the view that few cases would need it postoperatively.

In (htis series the author reviewed retrospectively 42 patients with posterior fossa tumors and hydrocephalus Ircnled "at Suez Canal University Hospital between June 1996 and December 2006, in an attempt to determine the requirement for shunt procedures in these patients.

All patients were treated primarily by posterior fossa craincctomy aiming for total tumor resection.

Prior to surgery 8 patients had endoscopic third ventriculostomy and 5 had external ventricular drain to relieve pressure.

The factors evaluated included age at diagnosis, tumor type, extent of surgical resection, and the presence of CSF leak and / or infection.

Patients were followed clinically and radio logically by enhanced CT and / or MRI during the postoperative period.

The average age of the patients was 19.3(1 -52) years.

24 patients were males and 18 were females.

The majority of patients were harboring aslrocylomas of different grades (36.8%, N = 14) followed by medulloblastom (26.3%, N =I 0).

In 76% of patients (N = 32) the tumor was totally resected.

The average follow-up was 22 (6-84) months.

The outcome was excellent in 62% (N = 26) of patienls, and good in 19% (N=8).

Ten patients required lumbar puncture for postoperative temporary management of CSF, Shunt placement was required postoperatively in 14.3% of patients (N = 6) Age of the patient was a significant factor in the need for shunt placement.

Tumor type and location as well as completeness of tumor excision were also important factors in predicting ihe need for post-operative shunt inserlion.

Persistence of a pseudomeningocele will eventually require placement of a shunt.