Abstract
Most patients who present with a fourth ventricle tumor have concurrent hydrocephalus, and some demonstrate persistent hydrocephalus after tumor resection. There is still no consensus on the management of hydrocephalus in patients with fourth ventricle tumor after surgery. The purpose of this study was to identify the factors that predispose to postoperative hydrocephalus and the need for a postoperative cerebrospinal fluid (CSF) diversion procedure. We performed a retrospective analysis of patients who underwent surgery of the fourth ventricle tumor between January 2013 and December 2018 at the Department of Neurosurgery in West China Hospital of Sichuan University. The characteristics of patients and the tumor location, tumor size, tumor histology, and preventive external ventricular drainage (EVD) that were potentially correlated with CSF circulation were evaluated in univariate and multivariate analysis. A total of 121 patients were enrolled in our study; 16 (12.9%) patients underwent postoperative CSF drainage. Univariate analysis revealed that superior extension (p = 0.004), preoperative hydrocephalus (p<0.001), and subtotal resection (p<0.001) were significantly associated with postoperative hydrocephalus. Multivariate analysis revealed that superior extension (p = 0.013; OR = 44.761; 95% CI 2.235-896.310) and subtotal resection (p = 0.005; OR = 0.087; 95% CI 0.016-0.473) were independent risk factors for postoperative hydrocephalus after resection of fourth ventricle tumor. Superior tumor extension (into the aqueduct) and failed total resection of tumor were identified as independent risk factors for postoperative hydrocephalus in patients with fourth ventricle tumor.
Highlights
Univariate analysis revealed that superior extension (p = 0.004), preoperative hydrocephalus (p
Multivariate analysis revealed that superior extension (p = 0.013; OR = 44.761; 95% CI 2.235–896.310) and subtotal resection (p = 0.005; OR = 0.087; 95% CI 0.016–0.473) were independent risk factors for postoperative hydrocephalus after resection of fourth ventricle tumor
Superior tumor extension and failed total resection of tumor were identified as independent risk factors for postoperative hydrocephalus in patients with fourth ventricle tumor
Summary
Surgery for fourth ventricular tumors is plagued by potential pitfalls caused by proximity to deep eloquent structures and the risk of injury to perforating arteries supplying subcortical regions and lesions of the fourth ventricle, which make up only a fraction of this subset.[13, 14] The lack of cases limits clinical experience data on the spectrum of pathologies in this region.[2,3,4,5,6,7,8,9, 15,16,17,18] We aimed to sought factors, which might be correlated with the development of persistent hydrocephalus following resection of fourth ventricle tumors to evaluate the indication for postoperative CSF drainage. The purpose of this study was to identify the factors that predispose to postoperative hydrocephalus and the need for a postoperative cerebrospinal fluid (CSF) diversion procedure
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