Análisis de complicaciones licuorales (hidrocefalia, fístula, pseudomeningocele e infección) en la cirugía de tumores de fosa posterior

Santamaría, D.; Blázquez, J.A.; Maíllo, A.; Caballero, Marı́a Dolores; Morales, Frumencio Medina; Muñoz, Adrián Quiles

doi:10.1016/s1130-1473(03)70548-x

Cited by 17 publications

(8 citation statements)

References 21 publications

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“…51 We only observed 1 case (1.9%) of postoperative infection. Another frequent complication was CSF leak, observed in 7.1% of the patients 52,53 (1 case in the present series). Cerebellar mutism has been reported 52 in almost 30% of posterior fossa craniotomies in children, but it was not observed in the reported CPP cases.…”

Section: Discussionmentioning

confidence: 52%

Posterior fossa choroidplexus papilloma in the pediatric population: case series and literature review

Pongeluppi,

Ballestero,

Santos

et al. 2023

Arq Neuropsiquiatr

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Choroid plexus papillomas (CPPs) are rare benign neoplasms which are particularly uncommon in the posterior fossa in children. We herein present a case series of five patients treated at a tertiary care hospital. A comprehensive literature review was also carried out. The patients treated at the tertiary care hospital were aged between 4 and 16 years. Gross total resection (GTR) was initially achieved in two patients. All patients showed clinical improvement. Moreover, 27 articles published between 1975 and 2021 were selected for the literature review, totaling 46 patients; with the 5 patients previously described, the total sample was composed of 51 cases, With a mean age was 8.2 years. The lesions were located either in the fourth ventricle (65.3%) or the cerebellopontine angle (34.7%). Hydrocephalus was present preoperatively in 66.7% of the patients, and a permanent shunt was required in 31.6% of the cases. The GTR procedure was feasible in 64.5%, and 93.8% showed clinical improvement. For CPPs, GTR is the gold standard treatment and should be attempted whenever feasible, especially because the role of the adjuvant treatment remains controversial. Neuromonitoring is a valuable tool to achieve maximal safe resection. Hydrocephalus is common and must be recognized and promptly treated. Most patients will need a permanent shunt. Though there is still controversy on its efficacy, endoscopic third ventriculostomy is a safe procedure, and was the authors' first choice to treat hydrocephalus.

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Section: Discussionmentioning

confidence: 52%

Posterior fossa choroidplexus papilloma in the pediatric population: case series and literature review

Pongeluppi,

Ballestero,

Santos

et al. 2023

Arq Neuropsiquiatr

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“…Overall morbidity associated with the raised features of hydrocephalus was reduced with this protocol. [ 9 ] Whereas complications related to this primary CSF diversion includes chances of tumor bleed and reverse herniation. [ 14 ]…”

Section: Discussionmentioning

confidence: 99%

“…[ 4 5 6 7 ] Persistent and/or progressive hydrocephalus occur in 10-62% of cases despite effective primary tumor decompression. [ 8 9 10 11 ] Two accepted modalities of treatment of this hydrocephalus are ventriculo-peritoneal shunt (VPS) or endoscopic third ventriculostomy (ETV). [ 7 12 13 14 ] The main debate is on the timing of the management of hydrocephalus.…”

Section: Introductionmentioning

confidence: 99%

Trans aqueductal, third ventricle – Cervical subarachnoid stenting: An adjuvant cerebro spinal fluid diversion procedure in midline posterior fossa tumors with hydrocephalus: The technical note and case series

Teegala

2016

Asian J Neurosurg

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Background:Persistent or progressive hydrocephalus is one of the complex problems of posterior fossa tumors associated with hydrocephalus. The author evaluated the effectiveness of single-stage tumor decompression associated with a stent technique (trans aqueductal third ventricle – Cervical subarachnoid stenting) as an adjuvant cerebro spinal fluid (CSF) diversion procedure in controlling the midline posterior fossa tumors with hydrocephalus.Materials and Methods:Prospective clinical case series of 15 patients was evaluated from July 2006 to April 2012. Fifteen clinicoradiological diagnosed cases of midline posterior fossa tumors with hydrocephalus were included in this study. All the tumors were approached through the cerebello medullary (telo velo tonsilar) fissure technique. Following the excision of the posterior fossa tumor, a sizable stent was placed across the aqueduct from the third ventricle to the cervical subarachnoid space.Results:There were nine male and six female patients with an average age of 23 years. Complete tumor excision could be achieved in 12 patients and subtotal excision with clearance of aqueduct in remaining three patients. Hydrocephalus was controlled effectively in all the patients. There were no stent-related complications.Conclusions:This study showed the reliability of single-stage tumor excision followed by placement of aqueductal stent. The success rate of this technique is comparable to those of conventional CSF diversion procedures. This is a simple, safe, and effective procedure for the management of persistent and or progressive hydrocephalus. This technique may be very useful in situations where the patient's follow-up is compromised and the patients who are from a poor economic background. Long-term results need further evaluation to assess the overall functioning of this stent technique.

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“…The incidence of cerebrospinal fluid (CSF) leak after posterior fossa surgery ranges between 1–14% in the literature 4 5 6 8 15 21 25 27 ). Factors associated with an increased risk of CSF leak in posterior fossa cases include larger tumor size 4 25) , post-operative meningitis 26) , re-operation 29) , and craniectomy rather than craniotomy 8) . CSF leak has also been associated with significant medical costs due to prolonged hospital stay and need for additional interventions 9) .…”

Section: Introductionmentioning

confidence: 99%

“…Pseudomeningoceles without CSF leak can present with cosmetic deformity and debilitating symptoms such as positional headache. The incidence of clinically relevant pseudomeningocele in the literature ranges from 4–23% 5 15 21 25 27 ).…”

Section: Introductionmentioning

confidence: 99%

Evaluation of Non-Watertight Dural Reconstruction with Collagen Matrix Onlay Graft in Posterior Fossa Surgery

Kshettry

Lobo

Lim

et al. 2016

J Korean Neurosurg Soc

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ObjectiveMany surgeons advocate for watertight dural reconstruction after posterior fossa surgery given the significant risk of cerebrospinal fluid (CSF) leak. Little evidence exists for posterior fossa dural reconstruction utilizing monolayer collagen matrix onlay graft in a non-watertight fashion. Our objective was to report the results of using collagen matrix in a non-watertight fashion for posterior fossa dural reconstruction.MethodsWe conducted a retrospective review of operations performed by the senior author from 2004–2011 identified collagen matrix (DuraGen) use in 84 posterior fossa operations. Wound complications such as CSF leak, infection, pseudomeningocele, and aseptic meningitis were noted. Fisher's exact test was performed to assess risk factor association with specific complications.ResultsIncisional CSF leak rate was 8.3% and non-incisional CSF leak rate was 3.6%. Incidence of aseptic meningitis was 7.1% and all cases resolved with steroids alone. Incidence of palpable and symptomatic pseudomeningocele in follow-up was 10.7% and 3.6% respectively. Postoperative infection rate was 4.8%. Previous surgery was associated with pseudomeningocele development (p<0.05).ConclusionWhen primary dural closure after posterior fossa surgery is undesirable or not feasible, non-watertight dural reconstruction with collagen matrix resulted in incisional CSF leak in 8.3%. Incidence of pseudomeningocele, aseptic meningitis, and wound infection were within acceptable range. Data from this study may be used to compare alternative methods of dural reconstruction in posterior fossa surgery.

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Análisis de complicaciones licuorales (hidrocefalia, fístula, pseudomeningocele e infección) en la cirugía de tumores de fosa posterior

Cited by 17 publications

References 21 publications

Posterior fossa choroidplexus papilloma in the pediatric population: case series and literature review

Posterior fossa choroidplexus papilloma in the pediatric population: case series and literature review

Trans aqueductal, third ventricle – Cervical subarachnoid stenting: An adjuvant cerebro spinal fluid diversion procedure in midline posterior fossa tumors with hydrocephalus: The technical note and case series

Evaluation of Non-Watertight Dural Reconstruction with Collagen Matrix Onlay Graft in Posterior Fossa Surgery

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