Postoperative communicating hydrocephalus in patients with supratentorial malignant glioma

Inamasu, Joji; Nakamura, Yoshiki; Saito, Ryoichi; Kuroshima, Yoshiaki; Mayanagi, Keita; Orii, Maaya; Ichikizaki, Kiyoshi

doi:10.1016/s0303-8467(03)00060-x

Cited by 39 publications

(36 citation statements)

References 11 publications

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“…Another study by Omuro et al (6) from the Memorial Sloan Kettering Cancer Center reported the outcome of 37 patients with leptomeningeal metastasis requiring VPS; in that particular cohort, 27/37 (77%) patients exhibited some overall improvement following surgery, which translated into a substantial improvement in the quality of life of terminally ill patients. Several other studies and case reports in the literature have confirmed the efficacy of VPS as palliative therapy in patients with CNS metastasis or primary brain tumors (14)(15)(16)(17).…”

Section: Discussionmentioning

confidence: 72%

“…Ventriculoperitoneal shunting (VPS) may rapidly normalize intracranial pressure (ICP) in the setting of hydrocephalus (6,(14)(15)(16)(17)(18). However, despite the fact that it is considered a minor invasive procedure, it does involve certain risks, such as hemorrhage, shunt malfunction, or infection (19)(20)(21); in addition, it may rarely result in peritoneal carcinomatosis due to seeding from the central nervous system (CNS) tumors (22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39).…”

Section: Introductionmentioning

confidence: 99%

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Role of ventriculoperitoneal shunting in patients with neoplasms of the central nervous system: An analysis of 59 cases

Nigim

Critchlow

Kasper

2015

Molecular and Clinical Oncology

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Abstract. Approximately 1-5% of patients with cerebral metastasis and ~40% of patients with primary brain tumors suffer from hydrocephalus. These patients often exhibit a poor prognosis. The aim of the present study was to reassess the validity of ventriculoperitoneal shunting (VPS) with the assistance of the general surgeon in oncological patients. A total of 59 patients underwent first-time VPS at the Beth Israel Deaconess Medical Center (Boston, USA) between 2004 and 2012; 40 patients had hydrocephalus from brain metastasis and 19 from primary tumors. The analyzed independent variables included demographics, body mass index, past medical history, clinical presentation, indication for surgery, Karnofsky performance status (KPS) score and surgical technique; the dependent variables were postoperative symptoms and occurrence, cause and time of shunt failure. The outcomes were analyzed with the t-test and Kaplan-Meier estimates for shunt survival. The mean age of the patients was 57.2 years and the mean operative time was 50.4 min. Symptomatic palliation was achieved in 93% of the cases; patients with severe symptoms, such as debilitating headaches, nausea and vomiting, benefited significantly from VPS. The mean follow-up time was 6.3 months; complications occurred in only 7 patients (11.8%) during follow-up: 2 in the proximal shunt (1 infection and 1 obstruction), both requiring revision, 1 infection in the distal catheter requiring shunt removal, 2 cases of intracerebral bleeding that were monitored with computed tomography scans, 1 wound infection treated with antibiotics and 1 valve complication that required temporary revision. The initial and 3-month KPS scores were 65±16.4 and 75±16.0, respectively. The mean overall shunt survival was 6.4 months (range, 1.0 day-76.0 months) from the placement of the VP shunt. At 3 months after VPS, 93.5% of the patients remained alive with functioning shunts and at 1 year 87% of the shunts were still functioning. In conclusion, VPS remains a valid option for cancer patients with low KPS, as it improves the quality of life in such patients, even in the setting of previous infection, hemorrhage, or leptomeningeal disease, since shunt patency outlasts the overall survival of nearly all patients.

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Section: Discussionmentioning

confidence: 72%

Section: Introductionmentioning

confidence: 99%

Role of ventriculoperitoneal shunting in patients with neoplasms of the central nervous system: An analysis of 59 cases

Nigim

Critchlow

Kasper

2015

Molecular and Clinical Oncology

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“…3,4,7,9) Clinically, some patients suffer progressive ventricular dilation, mainly caused by communicating hydrocephalus, after the diagnosis of recurrent GBM. 6,8,10,13) We and others have speculated that undetectable tumor dissemination at the initial stage is the cause of the subsequent hydrocephalus. If so, magnetic resonance (MR) imaging should indicate a specific sign such as ventricular dilation at recurrence, even before the definitive diagnosis of subsequent hydrocephalus.…”

Section: Introductionmentioning

confidence: 99%

Clinical Characteristics and Neuroimaging Findings in 12 Cases of Recurrent Glioblastoma With Communicating Hydrocephalus

Onuma

Ishikawa

Matsuda

et al. 2013

Neurol. Med. Chir.(Tokyo)

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Clinically, recurrent glioblastoma multiforme (GBM) is often associated with communicating hydrocephalus. We hypothesized that there are specific magnetic resonance (MR) imaging findings at the diagnosis of recurrent GBM that predict subsequent hydrocephalus. Various clinical characteristics were investigated including outcome and MR imaging findings in 12 patients with recurrent GBM followed by hydrocephalus (Hydro group) and 21 patients with recurrent GBM without hydrocephalus (Non-hydro group). Patient age and presence of communicating hydrocephalus were significantly associated with poor outcome. Median survival with recurrent GBM was longer in the Non-hydro group than in the Hydro group. Low Karnofsky performance status (KPS) and poor recursive partitioning analysis (RPA) class (RPA class 3, 5, 6, or 7) at the diagnosis of recurrent GBM were associated with the presence of hydrocephalus. The incidence of leptomeningeal dissemination after recurrent GBM was higher in the Hydro group than in the Non-hydro group. Evans index and fractional anisotropy value showed no difference at the diagnosis of recurrent GBM, but some MR imaging findings indicated that lesion attached to the basal cistern and/or ventricle was closely associated with subsequent hydrocephalus. We recommend careful monitoring of the ventricle size and leptomeningeal dissemination, especially in patients with low KPS and/or poor RPA class, if MR imaging indicates that the lesion is attached to the basal cistern and/or ventricle at recurrence of GBM.

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“…In addition, the routine clinical observation of such coregistered studies suggests that that ventricle size progressively increases in many of these patients. This is a poorly documented phenomenon, likely representing a communicating hydrocephalus [4]. The etiology is unclear, and is possibly related to the introduction of blood and proteins into the cerebral-spinal fluid (CSF) during surgery.…”

Section: Introductionmentioning

confidence: 99%

Segmentation propagation for the automated quantification of ventricle volume from serial MRI

Linguraru

Butman

2009

Medical Imaging 2009: Computer-Aided Diagnosis

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Accurate ventricle volume estimates could potentially improve the understanding and diagnosis of communicating hydrocephalus. Postoperative communicating hydrocephalus has been recognized in patients with brain tumors where the changes in ventricle volume can be difficult to identify, particularly over short time intervals. Because of the complex alterations of brain morphology in these patients, the segmentation of brain ventricles is challenging. Our method evaluates ventricle size from serial brain MRI examinations; we (i) combined serial images to increase SNR, (ii) automatically segmented this image to generate a ventricle template using fast marching methods and geodesic active contours, and (iii) propagated the segmentation using deformable registration of the original MRI datasets. By applying this deformation to the ventricle template, serial volume estimates were obtained in a robust manner from routine clinical images (0.93 overlap) and their variation analyzed.

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Postoperative communicating hydrocephalus in patients with supratentorial malignant glioma

Cited by 39 publications

References 11 publications

Role of ventriculoperitoneal shunting in patients with neoplasms of the central nervous system: An analysis of 59 cases

Role of ventriculoperitoneal shunting in patients with neoplasms of the central nervous system: An analysis of 59 cases

Clinical Characteristics and Neuroimaging Findings in 12 Cases of Recurrent Glioblastoma With Communicating Hydrocephalus

Segmentation propagation for the automated quantification of ventricle volume from serial MRI

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