Cerebrospinal fluid disturbances after 381 consecutive craniotomies for intracranial tumors in pediatric patients

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>The aim of this study was to investigate the incidence of CSF disturbances before and after intracranial surgery for pediatric brain tumors in a large, contemporary, single-institution consecutive series.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>All pediatric patients (those &lt; 18 years old), from a well-defined population of 3.0 million inhabitants, who underwent craniotomies for intracranial tumors at Oslo University Hospital in Rikshospitalet between 2000 and 2010 were included. The patients were identified from the authors' prospectively collected database. A thorough review of all medical charts was performed to validate all the database data.</jats:p></jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>Included in the study were 381 consecutive craniotomies, performed on 302 patients (50.1% male, 49.9% female). The mean age of the patients in the study was 8.63 years (range 0–17.98 years). The follow-up rate was 100%. Primary craniotomies were performed in 282 cases (74%), while 99 cases (26%) were secondary craniotomies. Tumors were located supratentorially in 249 cases (65.3%), in the posterior fossa in 105 (27.6%), and in the brainstem/diencephalon in 27 (7.1%). The surgical approach was supratentorial in 260 cases (68.2%) and infratentorial in 121 (31.8%). Preoperative hydrocephalus was found in 124 cases (32.5%), and 71 (86.6%) of 82 achieved complete cure with tumor resection only. New-onset postoperative hydrocephalus was observed in 9 (3.5%) of 257 cases. The rate of postoperative CSF leaks was 6.3%.</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>Preoperative hydrocephalus was found in 32.5% of pediatric patients with brain tumors treated using craniotomies. Tumor resection alone cured preoperative hydrocephalus in 86.6% of cases and the incidence of new-onset hydrocephalus after craniotomy was only 3.5%.</jats:p></jats:sec>

Risk factors for hydrocephalus following fourth ventricle tumor surgery: A retrospective analysis of 121 patients

“…[1][2][3][4][5][6] Although in posterior fossa tumor, tumor removal can restore CSF circulation, 10-30% of patients tend to experience persistent hydrocephalus following posterior fossa resection. [4,5,[7][8][9] The patients may present with signs and symptoms of increased intracranial pressure from hydrocephalus (headache, nausea/vomiting, vertigo, unsteady gait, diplopia, papilledema, etc. ), which affect the patient's life quality and may result in a prolonged hospital stay.…”

“…[13,14] The lack of cases limits clinical experience data on the spectrum of pathologies in this region. [2][3][4][5][6][7][8][9][15][16][17][18] We aimed to sought factors, which might be correlated with the development of persistent hydrocephalus following resection of fourth ventricle tumors to evaluate the indication for postoperative CSF drainage.…”

Stereotactic Placement of Intratumoral Catheters for Continuous Infusion Delivery of Herpes Simplex Virus -1 G207 in Pediatric Malignant Supratentorial Brain Tumors

“…There is also risk of CSF leak, that can be seen with tumor biopsies and resections. 38 The phenomenon of an intraoperative CSF leak after durotomy may serve as a source of brain shift that may contribute to the error observed in the placement of a stereotactic catheter. 39…”

Liquorrhea after removal of fourth ventricle tumors in children. Retrospective analysis of a series of 211 primary surgeries

“…Дренирование ликвора через наружный вентрикулярный дренаж, периодические люмбальные пункции -все это, с одной стороны, приводит к более быстрой санации ликвора, а с другой -эффективно снижает ликворное давление в течение первых 4-5 сут после операции, обеспечивая естественную герметизацию раны в процессе заживления. Работы, подтверждающие, что проблема ликвореи и псевдоменингоцеле -не проблема герметичности зашивания ТМО, а скорее проблема ликвородинамики, подтверждают нашу точку зрения [11,15]. В таком случае неудивительно, что мы не получили дополнительного эффекта от использования герметиков (Тахокомба и фибрин-тромбинового клея).…”