Delayed hydrocephalus after resection of supratentorial malignant gliomas.

Abstract

To report our experience with 12 patients who developed delayed hydrocephalus after resection of supratentorial malignant gliomas. The charts of all affected patients were analysed retrospectively for clinical presentation, time interval between initial operation and occurrence of hydrocephalus, neuroradiological findings, constituents of cerebrospinal fluid (CSF), surgical treatment, and outcome. After initial good recovery following tumour resection all patients deteriorated secondarily due to development of hydrocephalus which was not encountered in the first postoperative CT-scans. Incidence is 3.4% overall and is 8.3% if exclusively calculated for frontal gliomas but increases to 15.2% if specified for patients with ventricular entry during tumour resection. Development of hydrocephalus is suggested to be due to proteinic precipitation since analysis of CSF revealed marked elevation of proteins in all patients. Whereas shunting of mere hydrocephalus yields satisfactory results outcome in cases of multiloculated hydrocephalus necessitating placement of multiple catheters is questionable. Development of hydrocephalus after resection of malignant gliomas is not rare. It should be considered in patients with delayed deterioration after initial improvement. Outcome in relation to hydrocephalus is favourable in cases of mere communicating hydrocephalus, occurrence of multiloculated hydrocephalus, however, heralds a poor prognosis.