Shunt dependency in supratentorial intraventricular tumors depends on the extent of tumor resection

Abstract

Background Supratentorial intraventricular tumors (SIVTs) are rare lesions of various entities characteristically presenting with hydrocephalus and often posing a surgical challenge due to their deep-seated localization. We aimed to elaborate on shunt dependency after tumor resection, clinical characteristics, and perioperative morbidity. Methods We retrospectively searched the institutional database for patients with supratentorial intraventricular tumors treated at the Department of Neurosurgery of the Ludwig-Maximilians-University in Munich, Germany, between 2014 and 2022. Results We identified 59 patients with over 20 different SIVT entities, most often subependymoma (8/59 patients, 14%). Mean age at diagnosis was 41 ± 3 years. Hydrocephalus and visual symptoms were observed in 37/59 (63%) and 10/59 (17%) patients, respectively. Microsurgical tumor resection was provided in 46/59 patients (78%) with complete resection in 33/46 patients (72%). Persistent postoperative neurological deficits were encountered in 3/46 patients (7%) and generally mild in nature. Complete tumor resection was associated with less permanent shunting in comparison to incomplete tumor resection, irrespective of tumor histology (6% versus 31%, p = 0.025). Stereotactic biopsy was utilized in 13/59 patients (22%), including 5 patients who received synchronous internal shunt implantation for symptomatic hydrocephalus. Median overall survival was not reached and did not differ between patients with or without open resection. Conclusions SIVT patients display a high risk of developing hydrocephalus and visual symptoms. Complete resection of SIVTs can often be achieved, preventing the need for long-term shunting. Stereotactic biopsy along with internal shunting represents an effective approach to establish diagnosis and ameliorate symptoms if resection cannot be safely performed. Due to the rather benign histology, the outcome appears excellent when adjuvant therapy is provided.

A scoring system categorizing risk factors to evaluate the need for ventriculoperitoneal shunt in pediatric patients after brain tumor resection

“…This underscores the clinical importance of total resection. Furthermore, total resection played an independent protective role, which is consistent with certain studies ( 14 , 22 ) although some studies have reported conflicting results ( 9 , 15 , 23 ). This discrepancy could potentially be attributed to the limited number of cases involving incomplete total resections.…”

“…Several studies have emphasized the significant role of age, preoperative hydrocephalus, total resection, and tumor pathologies to predict postoperative hydrocephalus in children with brain tumors, while inconsistent findings prevented from comprehensively evaluating risks (8,12,13). Factors such as limited sample sizes, variations in variables, different tumor locations (supratentorial or infratentorial), varying age definitions (ranging from < 16 to < 20 years old), and differences in statistic methods (univariate or multivariate), might contribute to these inconsistencies (9,14). Moreover, Hu et al has made a novel discovery regarding the blood loss (BL) as an independent predictor for hydrocephalus in the children with infratentorial tumors (15).…”

Evaluation of surgical treatment strategies and outcome for cerebral arachnoid cysts in children and adults

“…Furthermore, the risk of catheter dysfunction after implantation in a hemorrhaged arachnoid cyst should be avoided. The stereotactical implantation of a catheter to drain intracerebral cysts has been specified and published in our and also other neurosurgical departments through years of experience and showed comparable effects in symptom improvement and complications compared to open cyst drainage [ 17 , 22 , 24 , 34 , 40 ]. We only used frame-based stereotactic catheter implantation in our cohort, so no statement can be made regarding frameless electromagnetic image-guided catheter implantation in our patient cohort.…”

“…Surgical interventions included microsurgical and/or endoscopic procedures (ME) to fenestrate or resect parts of the cyst wall to establish continuous drainage into the physiologic CSF pathways. For minimal-invasive treatment, an internal shunt catheter was implanted stereotactically (STX) to connect the cyst to the ventricular system and/or the basal cisterns depending on the individual CAC localization and configuration [ 40 ]. For the latter technique, surgical planning (iPlan stereotaxy; Brainlab, Munich, Germany) was based on a stereotactically localized contrast-enhanced computed tomography (CT) scan (0.6 mm slice thickness) and the preoperative MRI data (T1-weighted without contrast, T2-weighted/CISS sequences, contrast-enhanced magnetic resonance angiography), which were co-localized with the CT scan.…”

Risk-benefit analysis of surgical treatment strategies for cystic craniopharyngioma in children and adolescents

“…Additional catheter perforations were added manually to allow optimal upand downstream drainage. This technique has been specified and published in our and also other neurosurgical departments through years of experience (16)(17)(18)(19)(20). The catheter was fixed extracranially with a hemoclip (Titanium Ligation-Clip, 150mm length, B Braun, Melsungen, Germany) placed orthogonally on the catheter on the calvaria preventing the catheter from sliding into the brain.…”