Endoscopic Third Ventriculostomy before Posterior Fossa Tumor Surgery in Adult Patients

Marx, Sascha; Damaty, Ahmed El; Manwaring, Jotham; Refaee, Ehab El; Fleck, Steffen; Fritsch, Michael; Gaab, M. R.; Schroeder, Henry W. S.; Baldauf, Jörg

doi:10.1055/s-0037-1608786

Cited by 18 publications

(9 citation statements)

References 32 publications

(45 reference statements)

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“…1,31,32,38,39 Definitive measures refer to surgeries that seek to restore CSF circulation (endoscopic third ventriculocisternostomy -ETV-and ventriculoperitoneal/atrial shunt -VPS/VAS-) and tumor resection. 29,32,[40][41][42][43][44][45] There is still controversy regarding the opportune moment and the therapeutic measure of choice. Faced with this dilemma, several questions arise: 1.…”

Section: Therapeutic Approachmentioning

confidence: 99%

“…It is the treatment of choice in patients with asymptomatic hydrocephalus or with mild symptoms, both in primary tumors and in metastatic lesions. 32,36,44 In patients presenting with pre-surgical hydrocephalus, tumor resection can resolve it in 70-90% in children, and up to 96% in adults. 36 However, the risk of persistence of hydrocephalus, or new onset postoperatively, is estimated at 20-40% in pediatric patients 1,36 and 5.7-14.3% in adults.…”

Section: Early Tumor Resectionmentioning

confidence: 99%

“…As in pediatric patients, the trend of recent decades places ETV above VPS/VAS. [41][42][43][44] ETV is the procedure of choice for the treatment of symptomatic obstructive hydrocephalus due to primary and/or metastatic tumor lesions, presenting good efficacy and a low rate of complications. 32,[41][42][43][44] In cerebellar metastases, the performance of ETV is similar to VPS/VAS, but at a lower cost and with less morbidity.…”

Section: Adultsmentioning

confidence: 99%

“…[41][42][43][44] ETV is the procedure of choice for the treatment of symptomatic obstructive hydrocephalus due to primary and/or metastatic tumor lesions, presenting good efficacy and a low rate of complications. 32,[41][42][43][44] In cerebellar metastases, the performance of ETV is similar to VPS/VAS, but at a lower cost and with less morbidity. EVT appears to be less effective in individuals with metastatic lesions with a history of neuroinfection, intraventricular hemorrhage, and leptomeningeal carcinomatosis.…”

Section: Adultsmentioning

confidence: 99%

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Hydrocephalus secondary to tumors of the posterior fossa: review article

Palacios¹,

Alvis-Miranda²,

Pacheco³

2022

JNSK

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Posterior fossa (PF) tumors are a common cause of obstructive hydrocephalus. In adults, metastases are the most common tumors in PF. Among the primary neoplasms, the most common are meningioma, vestibular schwannoma, and hemangioblastoma. Glial tumors are the most prevalent in children and adolescents, followed by medulloblastoma and ependymomas. Surgical treatments are of choice in hydrocephalus due to posterior fossa tumors (HPFt). Tumor resection may be sufficient as monotherapy in adults with asymptomatic hydrocephalus and in others with a low risk of postoperative hydrocephalus. Endoscopic third ventriculoscisternostomy (ETV) is the choice for prophylaxis and / or treatment of HPFt in children-adolescents and adults. Ventriculoperitoneal bypass is beneficial in children-adolescents and adults with relative contraindications for EVT and / or unfavorable anatomy for it. External ventriculostomy is useful in adults who require emergency cerebrospinal fluid drainage.

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Section: Therapeutic Approachmentioning

confidence: 99%

Section: Early Tumor Resectionmentioning

confidence: 99%

Section: Adultsmentioning

confidence: 99%

Section: Adultsmentioning

confidence: 99%

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Hydrocephalus secondary to tumors of the posterior fossa: review article

Palacios¹,

Alvis-Miranda²,

Pacheco³

2022

JNSK

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“…EVD or VPS placement before tumour removal is a diffuse practice in paediatric population that cannot be considered an unnecessary surgical procedure such as in adults, because of the higher percentage of persistent hydrocephalus in children [6,17,19,57,63]. Preoperative ETV failure in posterior fossa tumour surgery has been largely described [38,57,58,61,66], and prone position may contribute to determining stoma occlusion for blood clot deposition (snow glob effect) [61]. A recent study by Srinivasan et al [58] analysed the utility of preoperative ETV, observing that it does not prevent the need for post-resection CSF shunt and that ETV failure is higher in case of posterior fossa ependymoma surgery.…”

Section: Pre-resection Etvmentioning

confidence: 99%

The role of external ventricular drainage for the management of posterior cranial fossa tumours: a systematic review

et al. 2020

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Posterior cranial fossa tumours frequently develop hydrocephalus as first presentation in up to 80% of paediatric patients and 21.4% of adults, although it resolves after tumour removal in 70-90% and 96%, respectively. New onset hydrocephalus is reported in about 2.1% of adult and 10-40% of paediatric patients after posterior fossa surgery. There is no consensus concerning prophylactic external ventricular drainage (EVD) placement that is frequently used before posterior fossa lesion removal, as well in those cases without clear evidence of hydrocephalus. The aim of the study was to define the most correct management for patients who undergo posterior fossa tumour surgery, thus identifying cohorts of patients who are at risk of persistent hydrocephalus prior to surgery. A systematic review of literature has been performed, following PRISMA guidelines. Most of the studies reported CSF shunt only in the presence of hydrocephalus, whereas only a few authors suggested its prophylactic use in the absence of signs of ventricular dilatation. Predictive factors for postoperative hydrocephalus has been identified, including young age (< 3 years), severe symptomatic hydrocephalus at presentation, EVD placement before surgery, FOHR index > 0.46 and Evans index > 0.4, pseudomeningocele, CSF leak and infection. The use of pre-resection CSF shunt in case of signs and symptoms of hydrocephalus is mandatory, although it resolves in the majority of cases. As reported by several studies included in the present review, we suggest CSF shunt also in case of asymptomatic hydrocephalus, whereas it is not indicated without evidence of ventricular dilatation.

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