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

Abstract

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.

The semi-sitting position in patients with indwelling CSF shunts: perioperative management and avoidance of complications

“…Nevertheless, preoperative treatment remains mandatory in symptomatic patients. Treatment options include perioperative placement of an external ventricular drain, endoscopic third ventriculostomy or the insertion of a CSF shunt [ 2 , 4 , 19 ].…”

“…Posterior fossa tumors are often associated with hydrocephalus at presentation, which commonly resolves after tumor removal. Nevertheless, cerebrospinal fluid (CSF) shunting may be mandatory prior to tumor resection in symptomatic cases [ 2 , 4 , 27 ]. Furthermore, hydrocephalus may be attributable to concomitant hydrocephalus not related to the posterior fossa tumor in the rare case, necessitating permanent CSF diversion.…”

Placement of EVD in pediatric posterior fossa tumors: safe and efficient or old-fashioned? The Vienna experience

“…[19][20][21] Compared to series using ETV as the treatment of choice, we encountered similar rates. [3,6,8,22] Moreover, Srinivasan et al recently showed that the use of an ETV before tumor resection did not prevent the need for postresection CSF diversion. [3] Based on their ndings they changed the practice at their institution again.…”

Commentary: Permanent Cerebrospinal Fluid Diversion in Adults With Posterior Fossa Tumors: Incidence and Predictors

“…[1][2][3][4][5][6][7] In the latter group, options are subdivided into external ventricular drain (EVD), endoscopic third ventriculostomy (ETV), or ventriculoperitoneal shunt (VPS) placement. 2,[7][8][9] A plethora of studies have reported results in each subgroup including long-term durability of ETV vs VPS. 3 Series report either homogenous, singlepathology cohorts or pool data from diverse P-FT pathologies.…”