Value of precraniotomy shunts in children with posterior fossa tumours

Abstract

Seventy children with posterior fossa tumours treated over a period of 6 1/2 years were studied. Most patients presented in the late stage of disease. Sixty-four required insertion of a precraniotomy shunt for one or more of the following: persistent vomiting, severe headache, dehydration, poor general condition, failing vision, altered sensorium, marked periventricular lucency, and brain stem involvement deferring total removal of the tumour. Insertion of precraniotomy shunt improved the general condition and signs and symptoms of increased intracranial pressure. It also provided a lax brain during definitive surgery and a smooth postoperative course. Shunt-related complications, consisting of block and/or infection, were observed in 21 patients. It was concluded that precraniotomy shunt is important in the management of children with posterior fossa tumours in developing countries where these patients present in the late stage of disease.

Outcome analysis of ventriculoperitoneal shunt procedures in hydrocephalus due to tubercular meningitis and non-infective cases

“…20 Some studies have suggested that preoperative shunting can be encouraged. 21 Obviously, this resulted in 100% of the patients becoming either shunt-dependent or at least having a permanently inserted shunt after surgery for posterior fossa tumors. In 1985, the American Society for Pediatric Neurosurgery commissioned a study to try to determine which position was recommendable.…”

Editorial: Complications following preresection shunting in patients with posterior fossa tumors

“…3 Interestingly, almost half of the patients in this paper had shunts inserted in the OR on the day of presentation or the following day. One wonders if time could have been made for early resection, given that time for placement of a shunt was available.…”

“…Unfortunately, primary resection of posterior fossa tumors is difficult to apply at our institution because we have the same problem as other developing countries, i.e., a very high referral rate of children with large posterior fossa tumors due to relatively late diagnosis, exceeding our tumor excision capacity and resulting in a long waiting list. 1,3 Tumor resection is typically performed on an elective basis in a special, wellequipped surgical theater by senior neurosurgical staff. Conversely, most children with severe hydrocephalus have shunts inserted by neurosurgical residents on an emergency basis, and most patients are typically discharged on the 2nd day and asked to return 1 day prior to the scheduled day of definitive surgery (approximately 10-14 days later).…”

“…3 Of 301 patients who underwent CSF diversion days prior to tumor resection, 5 patients had evidence of intratumoral hemorrhage (ITH) and 2 had upward transtentorial herniation (UTH) precipitating a decline in their neurological examination. These investigators conclude that infratentorial complications following CSF diversion before resection are rare, but that the prognosis for these patients is quite poor.…”

Cerebrospinal fluid disturbances after 381 consecutive craniotomies for intracranial tumors in pediatric patients

“…Precraniotomy shunting has been largely abandoned and replaced by preoperative ETV or EVD as effective modalities for CSF diversion in more contemporary series. 1,9,15,16,25,33,36,39 Feng et al 11 concluded in their series of 58 patients (including both children and adults) that ETV prior to surgery is a most effective treatment for cases of preoperative obstructive hydrocephalus caused by aqueductal stenosis and space-occupying lesions. In the same study, shunt independence after ETV was achieved in 82% of patients with tumor-related obstructive hydrocephalus.…”