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Analysis of means of proportions for histology and VP shunt dependency. Shaded area represents the 95% confidence interval for the proportion of VP shunt dependency for each histology type. Red dots indicate statistical significance at 5% level, green dots represent non-significance. Choroid plexus tumors and craniopharyngiomas showed significant association with VP shunt dependency. HGG high-grade glioma, LGG low-grade glioma, PNET primitive neuro-ectodermal tumor
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The risk of developing a de novo shunt-dependent hydrocephalus (HC) after undergoing a craniotomy for brain tumor in adult patients is largely unknown. All craniotomies for intracranial tumors at Oslo University Hospital in adult patients ≥18 years of age during a 10-year period (2004-2013) were included. None were lost to follow-up. Patients who d...
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Pineal region tumors commonly present with non-communicating hydrocephalus. These heterogeneous histological entities require different therapeutic regimens. We evaluated our surgical experience concerning procurance of a histological diagnosis, management of hydrocephalus, and choice of antitumoral treatment. We analyzed the efficacy of neuroendos...
Introduction:Hydrocephalus is one of the most common diseases in children, and its treatment
requires brain operation. However, the pathophysiology of the disease is very complicated and
still unknown.
Methods: Endoscopic Third Ventriculostomy (ETV) and Ventriculoperitoneal Shunt (VPS)
implantation are among the common treatments of hydrocephalus....
Background and Aim: Hydrocephalus is a common complication of intraventricular brain tumors. The present study was conducted to determine demographic and clinical features and type of hydrocephalus in patients with intraventricular brain tumors before and after surgical interventions.
Methods and Materials/Patients: The present cross-sectional stud...
Citations
... Tumor recurrence before surgery, n (%) 11 who had preoperative hydrocephalus, 47 (58%) had complete relief of hydrocephalus following brain tumor surgery. Of 45 patients with shunt surgery, 43 (95.6%) and 2 (4.4%) underwent VP and lumboperitoneal shunt procedures, respectively. ...
... 5,10 This study showed that 11 of 98 patients (11.2%) without preoperative hydrocephalus develop de novo postoperative hydrocephalus. Most of new-onset postoperative hydrocephalus often develops in the acute postoperative period 11 we also found the same result and all of them required shunt operations in subsequent period. ...
... 15,16 Furthermore, choroid plexus tumor and craniopharyngioma usually extend into the ventricular compartments, and ventricular approach for removing these tumors has an increased risk of postoperative hydrocephalus. 11 Intraventricular hemorrhage after brain tumor resection was a strong predictor of shunt-dependent hydrocephalus in our study. Blood products clog the arachnoid villi, obstruct the CSF pathway, bring about inflammation and scar formation of the CSF cisterns, and eventually result in development of postoperative hydrocephalus. ...
Hydrocephalus following brain tumor surgery is found, although cause of hydrocephalus is optimally eradicated. This study aimed to investigate factors associated with development of postoperative hydrocephalus that requires shunt procedure and generate predictive scoring model of this condition. Demographic, clinical, radiographic, treatment, laboratory, complication, and postoperative data were collected. Binary logistic regression was used to investigate final model for generating predictive scoring system of postoperative hydrocephalus. A total of 179 patients undergoing brain tumor surgery were included. Forty-five (25.1%) patients had postoperative hydrocephalus that required shunt surgery. In univariate analysis, several factors were found to be associated with postoperative hydrocephalus. Strong predictors of postoperative hydrocephalus revealed in multivariate analysis included tumor recurrence before surgery (odds ratio [OR], 4.38; 95% confidence interval [CI], 1.28–14.98; p = 0.018), preoperative hydrocephalus (OR, 6.52; 95% CI, 2.44–17.46; p < 0.001), glial tumor (OR, 3.76; 95% CI, 1.14–12.43; p = 0.030), metastasis (OR, 5.19; 95% CI, 1.72–15.69; p = 0.004), intraventricular hemorrhage (OR, 7.08; 95% CI, 1.80–27.82; p = 0.005), and residual tumor volume (OR, 1.05; 95% CI, 1.01–1.09; p = 0.007). A cutoff predictive score with the best area under curve and optimum cutoff point was utilized for discriminating patients with high risk from individuals with low risk in occurrence of postoperative hydrocephalus. This study reported predictive factors strongly associated with development of postoperative hydrocephalus. Predictive scoring system is useful for identifying patients with an increased risk of postoperative hydrocephalus. Patients classified in the high-risk group require closed surveillance of the hydrocephalus.
... The efficacy of craniotomy for brain tumors has been well established with regard to quality of life [2,4,28,34] and prolongation of life [16,20,27,28,40,43,44]. Although the primary aim may be to cure disease or restore neurological function [7], risks of surgery such as infection [30], bleeding [15,22,30], surgical morbidity and mortality [2,3,30,42], neurological deficits [5,6,25,32], and changes to cerebrospinal fluid (CSF) dynamics leading to hydrocephalus (HC) and subsequent ventriculoperitoneal (VP) shunt dependency [18,19] remain significant concerns to the neurosurgeon. ...
... The innate natural history of brain tumors or their surgical interventions may lead to HC that necessitates temporary CSF diversion procedures, such as external ventricular drainage (EVD) and/or endoscopic third ventriculostomy (ETV), or lead to permanent CSF diversion. Although the incidence and risk factors for development of postoperative HC leading to VP shunt dependency of patients with and Fig. 1 Flowchart illustrating all cases leading to VP shunt dependency and subsequently VP shunt failure within the study period without HC prior to a craniotomy for brain tumor have been previously described [18,19], the long-term outcomes of VP shunts in brain tumor patients are largely unknown. ...
Long-term risks and survival times of ventriculoperitoneal (VP) shunts implanted due to hydrocephalus (HC) after crani-otomy for brain tumors are largely unknown. The aim of this study was to establish the overall VP shunt survival rates during a decade after shunt insertion and to determine risks of shunt failure after brain tumor surgery in the long-term period. In this population-based cohort from a well-defined geographical region, all adult patients (> 18 years) from 2004 to 2013 who underwent craniotomies for intracranial tumors leading to VP shunt dependency were included. Our brain tumor database was cross-linked to procedure codes for shunt surgery (codes AAF) to extract brain tumor patients who became VP shunt dependent after craniotomy. The VP shunt survival time, i.e. the shunt longevity, was calculated from the day of shunt insertion after brain tumor surgery until the day of its failure. A total of 4174 patients underwent craniotomies, of whom 85 became VP shunt dependent (2%) afterwards. Twenty-eight patients (33%) had one or more shunt failures during their long-term follow-up, yielding 1-, 5-, and 10-year shunt success rates of 77%, 71%, and 67%, respectively. Patient age, sex, tumor location, primary/repeat craniotomy, placement of external ventricular drainage (EVD), ventricular entry, post-craniotomy hemorrhage, post-shunting meningitis/infection, and multiple shunt revisions were not statistically significant risk factors for shunt failure. Median shunt longevity was 457.5 days and 21.5 days for those with and without pre-craniotomy HC, respectively (p < 0.01). This study can serve as benchmark for future studies.
... Craniotomies for removal of brain tumors form the core treatment of these potentially deadly diseases and have been proven to prolong life [31,39] and improve quality of life and overall survival [20,33]. Nonetheless, infections [24,26,27], bleeding [13,27], surgical morbidity/mortality including neurological sequelae [2,27], and CSF disturbances [16][17][18]26] are potential risks of surgery. ...
... However, VP shunts may malfunction and studies on shunt longevity and potential risks leading to early shunt failures after brain tumor surgery remain unexplored. We have previously reported the incidence and risk factors of developing postoperative hydrocephalus in patients with and without hydrocephalus before brain tumor surgery [17,18]. Therefore, the primary end-point of this study was to investigate differences with respect to time to VP shunting, in particular between these two groups (patients with and without pre-craniotomy hydrocephalus). ...
... Adult patients without pre-craniotomy hydrocephalus who have undergone craniotomy for choroid plexus tumors and craniopharyngiomas have been shown to have higher risk of post-craniotomy shunt dependency [18]. This has also been demonstrated for adults with pre-craniotomy hydrocephalus and who have undergone secondary surgery [17]. ...
Risks and survival times of ventriculoperitoneal (VP) shunts implanted due to hydrocephalus after craniotomies for brain tumors are largely unknown. The purpose of this study was to determine the overall timing of VP shunting and its failure after craniotomy for brain tumors in adults. The authors also wished to explore risk factors for early VP shunt failure (within 90 days). A population-based consecutive patient cohort of all craniotomies for intracranial tumors leading to VP shunt dependency in adults (> 18 years) from 2004 to 2013 was studied. Patients with pre-existing VP shunts prior to craniotomy were excluded. The survival time of VP shunts, i.e., the shunt longevity, was calculated from the day of shunt insertion post-craniotomy for a brain tumor until the day of shunt revision requiring replacement or removal of the shunt system. Out of 4774 craniotomies, 85 patients became VP shunt-dependent (1.8% of craniotomies). Median time from craniotomy to VP shunting was 1.9 months. Patients with hydrocephalus prior to tumor resection (N = 39) had significantly shorter time to shunt insertion than those without (N = 46) (p < 0.001), but there was no significant difference with respect to early shunt failure. Median time from shunt insertion to shunt failure was 20 days (range 1–35). At 90 days, 17 patients (20%) had confirmed shunt failure. Patient age, sex, tumor location, primary/secondary craniotomy, extra-axial/intra-axial tumor, ventricular entry, post-craniotomy bleeding, and infection did not show statistical significance. The risk of early shunt failure (within 90 days) of shunts after craniotomies for brain tumors was 20%. This study can serve as benchmark for future studies.
... Smaller studies have also reported superior improvement of visual acuity and visual fields in craniopharyngioma patients treated via EEAs. [50][51][52][53] There are 2 mechanisms that may explain this finding. The first corresponds to the approach itself, with microsurgical approaches inherently having a higher degree of manipulation of the optic nerves, less preservation of the superior hypophyseal arteries, and increased dissections through narrow surgical corridors compared with endoscopic approaches. ...
Introduction
Adult craniopharyngiomas are low-grade tumors of the pituitary infundibulum that can be locally aggressive and frequently present with profound visual deficits and endocrinopathies. Surgical resection remains the preferred initial treatment for these lesions and recently endoscopic endonasal approaches (EEAs) have become increasingly utilized. However, minimal data exists comparing these techniques to traditional transcranial (TC) methods. The purpose of this study was to evaluate perioperative differences in EEA and TC approaches for adult craniopharyngiomas over the last several decades.
Methods
Craniopharyngioma surgeries in the Nationwide Inpatient Sample (NIS) from 1998 to 2014 were identified. Complication rates, mortality rates, and annual treatment trends were stratified by procedure. Annual caseload was assessed with linear regression and multivariate logistic regression models were created to determine predictors of inpatient mortality and perioperative complications.
Results
From 1998-2014, a significant increase in EEAs for craniopharyngiomas (+4.36/year, r²=0.80, p<0.0001) was observed. In contrast, no increase in TC surgeries for these lesions was seen. In multivariate analysis, EEAs were more likely to experience postoperative cerebrospinal fluid leak (OR=2.61, p<0.0001). However, EEAs were protective against all other perioperative complications, including diabetes insipidus, panhypopituitarism, visual impairment, and even mortality (OR=0.41, p=0.0007).
Conclusion
Over the last several decades, utilization of EEAs to resect adult craniopharyngiomas has increased. EEAs appear to be associated with lower rates of perioperative mortality and complications. However, long-term, prospective studies controlling for tumor size, location, and preoperative symptomatology are needed to determine when one approach should be utilized preferentially over the other.
... Studies on perioperative hydrocephalus (HC) related to intracranial tumor surgery have been reported in the past, but these have been limited to specific tumor histologies and/or tumor locations [8,19,47,50]. Analyses of risk factors of de novo postoperative HC with subsequent VP shunt dependency in brain tumor patients have been reported as well [26], and risk factors for developing postoperative HC in the pediatric population are reported to be younger age [12,54], surgical approach, tumor histology and infections [12,27,40], among others. However, in contemporary literature, there is gap in knowledge concerning incidence of preexisting HC and their surgical success rate of tumor resection. ...
... Fig. 1 Flow chart demonstrating pre-and postoperative hydrocephalus (HC) in all patients whom underwent craniotomy for intracranial tumors, with subsequent VP shunt dependency. a: patients with de novo postoperative HC and shunt dependency, adopted from Hosainey et al. [26] Tumor volume Mean tumor volume was 31.7 cm 3 (range 3.2-115 cm 3 ) in all 39 patients whom became VP shunt dependent. Tumor volume was not a significant risk factor for VP shunt dependency (p = .24) ...
... Recently, we reported on the incidence and risk factors for postoperative VP shunt dependency in brain tumor patients without preoperative HC and observed that 0.5% of adult patients developed de novo postoperative HC requiring permanent CSF diversion within 90 days after surgery [26]. With the primary aim of studying persisting HC post-craniotomy requiring surgical intervention, in this current study, we focused on adult patients with preexisting HC prior to brain tumor surgery and found that only 7.8% of the patients had preoperative HC (373/4774). ...
The efficacy of tumor removal via craniotomies on preoperative hydrocephalus (HC) in adult patients with intracranial tumors is largely unknown. Therefore, we sought to evaluate the effect of tumor resection in patients with preoperative HC and identify the incidence and risk factors for postoperative VP shunt dependency. All craniotomies for intracranial tumors at Oslo University Hospital in patients ≥ 18 years old during a 10-year period (2004–2013) were reviewed. Patients with radiologically confirmed HC requiring surgery and subsequent development of shunt dependency were identified by cross-linking our prospectively collected tumor database to surgical procedure codes for hydrocephalus treatment (AAF). Patients with preexisting ventriculoperitoneal (VP) shunts (N = 41) were excluded. From 4774 craniotomies performed on 4204 patients, a total of 373 patients (7.8%) with HC preoperatively were identified. Median age was 54.4 years (range 18.1–83.9 years). None were lost to follow-up. Of these, 10.5% (39/373) required permanent CSF shunting due to persisting postoperative HC. The risk of becoming VP shunt dependent in patients with preexisting HC was 7.0% (26/373) within 30 days and 8.9% (33/373) within 90 days. Only secondary (repeat) surgery was a significant risk factor for VP shunt dependency. In this large, contemporary, single-institution consecutive series, 10.5% of intracranial tumor patients with preoperative HC became shunt-dependent post-craniotomy, yielding a surgical cure rate for HC of 89.5%. To the best of our knowledge, this is the first and largest study regarding postoperative shunt dependency after craniotomies for intracranial tumors, and can serve as benchmark for future studies.
Objective
This study aims to identify the predictors of postoperative hydrocephalus in patients with posterior fossa tumors (PFTs) and guide the management of perioperative hydrocephalus.
Methods
We performed a single-institution, retrospective analysis of patients who underwent resection of PFTs in our department over a 10-year period (2011–2021). A total of 682 adult patients met the inclusion criteria and were divided into either a prophylactic external ventricular drainage (EVD) group or a nonprophylactic-EVD group. We analyzed data for the nonprophylactic-EVD group by univariate and multivariate analyses to identify predictors of postoperative acute hydrocephalus. We also analyzed all cases by univariate and multivariate analyses to determine the predictors of postoperative ventriculoperitoneal (VP) shunt placement.
Results
Tumor infiltrating the midbrain aqueduct [ P = 0.001; odds ratio (OR) = 9.8], postoperative hemorrhage ( P < 0.001; OR = 66.7), and subtotal resection ( P = 0.006; OR = 9.3) were independent risk factors for postoperative EVD. Tumor infiltrating the ventricular system ( P < 0.001; OR = 58.5) and postoperative hemorrhage ( P < 0.001; OR = 28.1) were independent risk factors for postoperative VP shunt placement.
Conclusions
These findings may help promote more aggressive monitoring and earlier interventions for postoperative hydrocephalus in patients with PFTs.
Background
Glioblastoma is the most common and the most challenging to treat adult primary central nervous system tumor. Although modern management strategies modestly improved the overall survival, the prognosis remains dismal associated with poor life quality and the clinical course often dotted by treatment side effects and cognitive decline. Functional deterioration might be caused by obstructive or communicating hydrocephalus but due to poor overall prognosis surgical treatment options are often limited and its optimal management strategies remain elusive. We aimed to investigate risk factors, treatment options and outcomes for tumor-associated hydrocephalus in a contemporary 10 years cohort of glioblastoma patients.
Methods
We reviewed electronic health records of 1800 glioblastoma patients operated at the Department of Neurosurgery, Medical Center – University of Freiburg from 2009 to 2019. Demographics, clinical characteristics and radiological features were analyzed. Univariate analysis for nominal variables was performed either by Fisher’s exact test or Chi-square test, as appropriate.
Results
We identified 39 glioblastoma patients with symptomatic communicating hydrocephalus treated by ventricular shunting (incidence 2.1%). Opening of the ventricular system during a previous tumor resection was associated with symptomatic hydrocephalus (p<0.05). There was also a trend toward location (frontal and temporal) and larger tumor volume. Number of craniotomies before shunting was not considered as a risk factor. Shunting improved hydrocephalus symptoms in 95% of the patients and Karnofsky Performance Score (KPS) could be restored after shunting. Of note, 75% of the patients had a post-shunting oncological treatment such as radiotherapy or chemotherapy, most prevalently chemotherapy. Infection (7.7%) and over- or under drainage (17.9%) were the most common complications requiring shunt revision in ten patients (25.6%), No peritoneal metastasis was found. The median overall survival (OS) was 385 days and the median post shunting survival was 135 days.
Conclusion
Ventricular system opening was identified as a risk factor for communicating hydrocephalus in glioblastoma patients. Although glioblastoma treatment remains challenging, shunting improved hydrocephalus-related functional status and may be considered even in a palliative setting for symptom relief.
OBJECTIVE. CT has excellent accuracy for appendicitis but is associated with risks. Research and educational campaigns have been conducted to implement an ultrasound-first strategy for children but not for adults. The purpose of this study was to measure the use of CT and ultrasound in emergency department (ED) visits for abdominal pain and appendicitis to examine the impact of these efforts. MATERIALS AND METHODS. We analyzed data from the National Hospital Ambulatory Medical Care Survey (1997-2016). Use of CT and ultrasound was measured over time in visits for abdominal pain and visits in which appendicitis was diagnosed. Predictors of CT use were identified by means of regression analysis. RESULTS. For children, CT use increased from 1.2% (95% CI, 0.6-2.5%) in 1997, peaked in 2010 at 16.6% (95% CI, 13.8-19.6%), and decreased slightly in 2016. In adults, CT use increased steadily from 3.9% in 1997 (95% CI, 3.1-4.8%) to 37.8% (95% CI, 35.5-41.0%) in 2016. CT use increased for both pediatric and adult ED visits with a diagnosis of appendicitis, from 5.2% (95% CI, 0.7-29.5%) to 71.0% (95% CI, 43.1-88.8%) for children and 7.2% (95% CI, 2.7-17.6%) to 83.3% (95% CI, 64.1-93.3%) for adults. Children with abdominal pain and a diagnosis of appendicitis evaluated in a pediatric ED were at decreased odds (pain odds ratio, 0.6 [95% CI, 0.3-0.9]; appendicitis odds ratio, 0.2 [95% CI, 0.0-0.7]) of receiving CT than were those evaluated in general EDs. CONCLUSION. CT use has decreased in the evaluation of abdominal pain in children, perhaps because of research findings and efforts to implement an ultrasound-first strategy for suspected appendicitis. In contrast, CT use has continued to increase among adults with abdominal pain in EDs.
OBJECTIVE. This article addresses the management of hydrocephalus and the CSF shunts used to treat this entity. CONCLUSION. CSF shunts have a high failure rate. Imaging plays a pivotal role in assessing CSF shunt failure and determining the need for surgical revision. An in-depth knowledge of CSF shunt components, their failure modes, and the corresponding findings on anatomic imaging studies is necessary to ensure timely diagnosis and prevent permanent neurologic damage.
With a recent trend towards supra-maximal resection for gliomas and minimally invasive techniques, keyhole temporal lobectomies may serve an important role in neurosurgical oncology. Due to their location and proximity to eloquent brain, temporal lobe gliomas offer unique challenges that may limit the extent of resection. Here we describe a modified technique using mini-craniotomies through a keyhole approach for temporal lobectomies in glioma patients. We retrospectively reviewed data from consecutive patients who underwent temporal lobectomies for resection of gliomas from 2012 to 2018. Demographic data, extent of tumor resection, pre and post-op KPS, short term and long term complications, as well as other relevant data were collected. We identified 57 patients who underwent keyhole-mini craniotomy for temporal lobectomies for glioma. Surgical procedures were performed in 12 patients for low-grade glioma (LGG) and 45 patients for high-grade glioma (HGG). Awake craniotomies were performed in 15 of the cases, and 13 cases were for tumor recurrence. Supra-maximal resection (SMR) was achieved in 15 patients, while gross total resection (GTR) and near total resection (NTR) achieved in 32 patients and 10 patients, respectively. Average pre- and post-op KPS were equivalent, and post-operative complications requiring surgical intervention were experienced in 4 patients. Here we show that our modified keyhole craniotomy is both safe and effective in achieving SMR or GTR in glioma patients, with minimal morbidity. This minimally-invasive temporal lobectomy may be an instrumental tool for neurosurgical oncologists transitioning to less invasive techniques.
