Clinical Outcome of Posterior Fossa Tumor Surgery Without Preoperative Ventriculo-peritoneal Shunt

Islam, Md. Saiful; Islam, KM Tarikul; Rashid, Md. Harun-Or; Dhakhal, S; Khair, Abul; Barua, KK; Hossain, Md. Akhtar

doi:10.3329/bmj.v40i1.9963

Cited by 4 publications

(4 citation statements)

References 7 publications

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“…Although the incidence of CSF leakage after posterior fossa surgery has been quoted to be as high as 26.7%14, the incidence ranges between 4 and 17% in most series 10,15. The incidence of 17% in our study was thus similar to these findings.…”

Section: Discussionsupporting

confidence: 89%

Management of Cerebrospinal Fluid Leak following Posterior Cranial Fossa Surgery

Altaf¹,

Vohra

Shams

2016

Pak J Med Sci

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Objective:Cerebrospinal fluid leakage remains a significant cause of morbidity following posterior fossa surgery, and its treatment remains a difficult problem. The aim of the study was to propose a treatment algorithm for its management.Methods:A retrospective, single-center study was conducted on 147 patients who underwent elective posterior fossa surgery for a variety of diseases. Patients with post operative CSF leakage had either been treated initially with conservative measures including re-suturing of the wound, with CSF lumbar drainage to be employed in case the CSF leakage didn’t stop, or the initial intervention was the institution of CSF lumbar drainage simultaneously with conservative measures. VP (ventriculo-peritoneal) shunt was done in patients with gross hydrocephalus on postoperative CT brain.Results:There were 25 (17%) cases of CSF leakage, including 24 incisional CSF leaks and one case of CSF otorrhea. In eight patients with incisional CSF leakage treated initially with conservative measures including re-suturing of the wound, CSF leakage stopped in only two cases. CSF lumbar drainage instituted later on in six cases with persistent leakage stopped the CSF leakage. In fourteen patients managed initially with re-suturing of the wound and concomitant CSF lumbar drainage, CSF leakage settled in all the cases. Two patients with gross hydrocephalus on post operative CT were managed successfully with VP shunt. Re-suturing of the wound with concomitant CSF lumbar drainage was found to be significantly associated (p=0.003) with the stoppage of CSF leakage, and the settlement of meningitis (p= 0.014).Conclusion:Incisional CSF leaks after posterior fossa surgery should be managed with re-suturing of the wound and concomitant CSF lumbar drainage, instead of an initial trial of conservative therapy alone.

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Section: Discussionsupporting

confidence: 89%

Management of Cerebrospinal Fluid Leak following Posterior Cranial Fossa Surgery

Altaf¹,

Vohra

Shams

2016

Pak J Med Sci

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“…Another investigation found just one occurrence of fatality, at 0.83 percent. 12 According to the most recent study, the mortality rate was 6.7 percent. 8…”

Section: Discussionmentioning

confidence: 98%

“…CSF leakage and pseudomeningocele were similarly shown to be the most prevalent postoperative complications in our study, accounting for about 15% of patients. Islam et al 12 reported that CSF leak was the commonest complication (26%), followed by pseudomeningocele (23%). Shaikh et al 13 researched 66 patients and found that medulloblastoma (29.26 percent) and pilocytic astrocytoma (29.26 percent) were the most prevalent posterior fossa brain tumors, which is very same as our study, which included 13 (32.5 percent) medulloblastoma and astrocytoma (32.5 percent).…”

Section: Discussionmentioning

confidence: 99%

Pediatric Posterior Fossa Brain Tumor Surgical Outcome

Awais¹,

Muner²,

Laeeq-ur-Rehman³

et al. 2022

Pak J Neurol Surg

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Objective: The study analyzed the complications and satisfactory surgical outcomes of posterior fossa brain tumor surgery in Lahore Medical City Lahore. Materials and Methods: A prospective study was conducted and included 40 children who were diagnosed with posterior fossa brain tumors by history, physical examination, and later radiologically were admitted and operated on at the Pediatric Neurosurgery Department in Lahore medical City Lahore between the period of March 2021 and March 2022. Results: There were 26 (65%) male and 14 (35% females) individuals among the 40 patients. The average age was 12.5 years. This study found that great surgical outcomes were observed in 10 instances (25 percent), good outcomes in 20 cases (50%), and bad outcomes in 10 cases (25%). The most frequent clinical manifestations were headache (38%), vomiting (30%), ataxia (10%), blurred vision (10%), and cranial nerve palsy (12.5%). The best prognosis is shown in children with Pilocytic astrocytoma, followed by ependymoma, while the poorest outcome is seen in children with medulloblastoma. Conclusion: Pediatric neurosurgeons continue to face particular difficulty in the surgical treatment of posterior fossa brain tumors. Our study compares the outcomes, complications, and surgical outcomes to prior clinical investigations.

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“…Relieving the hydrocephalus in the presence of posterior fossa tumor can cause sudden decompression. It may lead to the formation of extradural hematoma [18]. ETV and VP shunt are recommended as permanent treatment for hydrocephalus after posterior fossa tumor surgery [11].…”

Section: Discussionmentioning

confidence: 99%

Duration of Preoperative External Ventricular Drain in Pediatric Posterior Fossa Tumors—Does It Matter?

Ghani¹,

Al-Banyan²,

Sabbagh³

et al. 2017

OJPed

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Objective: Aim of the study was to assess the duration of preoperative external ventricular drain (EVD) as a predictor for permanent cerebrospinal fluid (CSF) diversion in pediatric posterior fossa tumors. Methods: The study was conducted in the Department of Pediatric Neurosurgery, National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia from January 2010 to December 2013. The data were collected retrospectively. The patients who had emergency insertion of external ventricular drain (EVD) due to hydrocephalus before the definitive posterior fossa tumor surgery were included in the study. Results: The preoperative emergency insertion of EVD was done in 38 patients with pediatric posterior fossa tumors. The patients were divided into two groups. Group A consists of those patients who had duration of preoperative EVD equal or less than 7 days. Group B includes those patients who had duration of preoperative EVD more than 7 days. Group A has 16 patients while Group B has 22 patients. The predominant clinical feature was symptoms and signs of raised intracranial pressure (ICP) only. Infection related to EVD was seen in seven patients. Ventriculoperitoneal (VP) shunt was required in 31.25% of Group A patients and 18.18% of Group B patients (p value = 0.35). Overall shunt rate was 23.68%. Conclusion: There are well known number of factors that can determine the need of permanent CSF diversion in patients with posterior fossa tumors. However, there is no effect of preoperative duration of EVD in determining the requirement of postoperative VP shunt.

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Clinical Outcome of Posterior Fossa Tumor Surgery Without Preoperative Ventriculo-peritoneal Shunt

Abstract: Abstract

Cited by 4 publications

References 7 publications

Management of Cerebrospinal Fluid Leak following Posterior Cranial Fossa Surgery

Management of Cerebrospinal Fluid Leak following Posterior Cranial Fossa Surgery

Pediatric Posterior Fossa Brain Tumor Surgical Outcome

Duration of Preoperative External Ventricular Drain in Pediatric Posterior Fossa Tumors—Does It Matter?

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