Fatal intratumoral hemorrhage in posterior fossa tumors following ventriculoperitoneal shunt

Santhanam, Ramachandran; Balasubramaniam, Anandh; Chandramouli, Balasubramanian

doi:10.1016/j.jocn.2008.02.016

Cited by 16 publications

(16 citation statements)

References 9 publications

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“…12,14,17,36,37,40,41,45 This is consistent with our results, which indicated that most of our cases deterio rated within 8 hours (85.7%); in particular, 2 patients dete riorated immediately, whereas 1 patient, the only survivor, deteriorated after 24 hours.…”

supporting

confidence: 91%

“…28 However, a number of complications have been as sociated with CSF diversion, including: supratentorial intracranial hematomas (e.g., extradural, subdural, intra cerebral, and intraventricular hemorrhage); many shunt associated complications, such as malfunction, infec tion, multiple abdominal complications, longterm shunt dependence, and metastases into the peritoneal cavity or vascular system; and infratentorial complications, e.g., in tratumoral hemorrhage (ITH) and upward transtentorial herniation (UTH). 2,14,18,29,30,40,41 Several case reports have been published describing the serious and mostly fatal infratentorial complications (ITH and/or UTH) that may occur as a result of preresectional CSF diversion, either by ventricular shunting 12,14,17,37,40,41,45 or ETV 36 in patients with posterior fossa tumors. There fore, the actual incidence of such complications is un known.…”

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confidence: 99%

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Infratentorial complications following preresection CSF diversion in children with posterior fossa tumors

El-Gaidi¹,

El-Nasr²,

Eissa³

2015

PED

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OBJECT This report presents the incidence, causes, and morbidity and mortality of infratentorial complications following CSF diversion before resection in children with posterior fossa tumors. METHODS The medical records of 437 children admitted to Abo El-Reesh Pediatric University Hospital with a diagnosis of posterior fossa tumor between 2005 and 2012 were retrospectively reviewed. Seven children developed neurological deterioration following CSF diversion due to infratentorial complications. Computed tomography scans revealed intratumoral hemorrhage (ITH) in 5 cases, while upward transtentorial herniation (UTH), as evidenced by obliteration of the quadrigeminal and ambient cisterns, was diagnosed in 2 cases. RESULTS Hydrocephalus was noted in 381 patients, and 301 patients underwent CSF diversion before resection. A ventriculoperitoneal (VP) shunt was used in 214 patients, and 6 children (2.8% of shunted cases) deteriorated neurologically (4 due to ITH and 2 due to UTH). Endoscopic third ventriculostomy (ETV) was performed in 87 patients, 1 of whom developed ITH (1.1% of the patients undergoing ETV). Six patients deteriorated within 8 hours (85.7%), whereas 1 patient, the only survivor, deteriorated after 24 hours. The incidence of infratentorial complications between VP shunts and ETVs was not found to be significantly different (p = 0.659). There was a higher risk of such complications in large posterior fossa tumors (diameter ≥ 4 cm) extending close to the tentorial incisura, especially in patients with severe hydrocephalus and significant peritumoral edema. CONCLUSIONS Infratentorial complications (ITH and UTH) in children with posterior fossa tumors are not uncommon (2.3%) after preresection CSF diversion (VP shunt or ETV) and are associated with a very poor prognosis in most cases, even with surgical intervention.

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confidence: 91%

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confidence: 99%

Infratentorial complications following preresection CSF diversion in children with posterior fossa tumors

El-Gaidi¹,

El-Nasr²,

Eissa³

2015

PED

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“…One report showed that 6 out of 7 patients died or were in a vegetative state, and one made a good recovery [5] . Most reported cases had a fatal clinical course [7,8,12] . The patient presented herein had a large-sized tumor with hypervascularity and a dural venous channel, and mild obstructive hydrocephalus was observed.…”

Section: Discussionmentioning

confidence: 99%

“…The first choice of therapy to control ICP should be early craniotomy and tumor resection. In these operations, the risk of CSF drainage must be balanced with the benefits, and the possibility of serious complications must be considered in posterior fossa tumors with obstructing hydrocephalus [5][6][7]12] . CSF drainage before surgical resection should not be routinely recommended for posterior fossa tumors.…”

Section: Discussionmentioning

confidence: 99%

Intraoperative Tumoral Bleeding of Hypervascular Medulloblastoma after Ventricular Drainage: A Case Report

Ryu

Jung²,

Han³

et al. 2016

Pediatr Neurosurg

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We report a rare case of intraoperative tumoral bleeding of a hypervascular medulloblastoma. A 12-year-old girl presented with dizziness and nausea. Brain magnetic resonance (MR) images revealed an approximately 4.2-cm enhanced mass on the cerebellar vermis associated with mild perilesional edema and increased cerebral blood volume. Angiography showed tumoral staining and developed occipital and circular dural sinuses in the venous phase. A suboccipital craniotomy was performed. To relieve the intracranial pressure, cerebrospinal fluid (CSF) was drained via a lateral ventricular catheter in the occipital horn. During the opening of the dura, the brain swelling had progressed, and brain computed tomography revealed an intratumoral hemorrhage with brainstem compression. The patient was in a stuporous mental state. A reoperation was performed, and the mass was totally removed. The pathologic findings revealed a medulloblastoma with abnormal enlarged arterial vascular structures. Postoperatively, the patient recovered to an alert mental state. She underwent chemotherapy and radiotherapy. There was no recurrence after 1 year. Pre-resectional CSF drainage should not be routinely performed in posterior fossa tumors, especially with increased cerebral blood volume on MR perfusion images. Complete removal should be performed quickly while CSF drainage should be performed slowly. An intratumoral hemorrhage should be considered in posterior fossa tumors when severe brain swelling suddenly develops after CSF drainage.

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“…The associated hemorrhage is commonly intratumoral and occurs in 6-10% of all brain tumors. [12] It most commonly occurs in glioblastoma multiforme (GBM), metastatic tumors, and pituitary adenomas. [1234]…”

Section: Introductionmentioning

confidence: 99%

Fatal intratumoral hemorrhage in tectal plate glioblastoma multiforme following ventriculoperitoneal shunt

Khalatbari¹,

Khalatbari

Moharamzad³

2014

J Pediatr Neurosci

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Ventriculo-peritoneal (V-P) shunting is an accepted procedure before a direct approach to large tumors producing obstructive hydrocephalus. However, it has been associated with some complications. Intratumoral hemorrhage is an uncommon but fatal complication of V-P shunt insertion. The exact mechanism of this complication is unknown, but several mechanisms have been proposed including rapid lowering of intracranial pressure following V-P shunt placement or cerebrospinal fluid (CSF) drainage and sudden decrease in CSF volume and pressure after V-P shunting. We report an 8-year-old girl who presented with severe headache, double vision, and bilateral papilledema. Brain magnetic resonance imaging with and without gadolinium administration revealed a large tectal plate tumor compressing the aqueduct which caused hydrocephalus. Due to progressive decline in consciousness level, an emergency CSF diversion was planned and she underwent left side posterior parietal V-P shunt placement. Eight hours after V-P shunt insertion, she suddenly developed tonic-clonic seizures and collapsed into deep coma with dilated pupils and stopped breathing and died 1-day later. Histological examination of the autopsy specimen showed the tumor was a glioblastoma multiforme with massive intratumoral hemorrhage. The possible pathophysiological mechanisms of this fatal complication are discussed here and the pertinent literature is reviewed. It seems that endoscopic third ventriculostomy is the procedure of choice for CSF diversion in patients with tectal plate gliomas and decreases the occurrence of intratumoral hemorrhage.

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Fatal intratumoral hemorrhage in posterior fossa tumors following ventriculoperitoneal shunt

Cited by 16 publications

References 9 publications

Infratentorial complications following preresection CSF diversion in children with posterior fossa tumors

Infratentorial complications following preresection CSF diversion in children with posterior fossa tumors

Intraoperative Tumoral Bleeding of Hypervascular Medulloblastoma after Ventricular Drainage: A Case Report

Fatal intratumoral hemorrhage in tectal plate glioblastoma multiforme following ventriculoperitoneal shunt

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