The Management of Hydrocephalus in Children with Posterior Fossa Tumours: The Role of Pre-Resectional Endoscopic Third Ventriculostomy

Abstract

Aims: The purpose of this retrospective case series was to determine the incidence of complications and outcomes associated with a primary management policy of endoscopic third ventriculostomy (ETV) prior to posterior fossa tumour resection in a single paediatric neurosurgical unit. Methods: Between July 1999 and August 2007, 59 children with posterior fossa tumours were surgically managed. Based on presenting neurology, imaging criteria and cerebrospinal fluid (CSF) pressure during ventriculostomy, patients were categorised into no (n = 16), mild (6), moderate (22) or severe (15) hydrocephalus on admission. Results: Thirty-seven (63%) patients underwent ETV within (mean) 1.5 days of admission, and of those, 32 (87.1%) exhibited significant improvement in presenting symptomology immediately after ETV. Complications arising after ETV included CSF infection/meningitis (n = 2) and bleeding (n = 1). ETV failed in 5/37 patients over the follow-up period. There was a significant association between increasing severity of hydrocephalus before ETV and increased number of complications (p = 0.03). Conclusions: The use of pre-resectional ETV at this institution is an effective and safe procedure with a high success rate at up to 7.5 years of follow-up. We believe that all paediatric neurosurgical institutions should review their practice regarding hydrocephalus associated with posterior fossa tumours in the light of the controversy surrounding perioperative CSF diversion.