Communicating hydrocephalus following surgery and adjuvant radiochemotherapy for glioblastoma

Clinical article

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Object

Communicating hydrocephalus is an uncommon complication in patients treated for glioblastoma multiforme (GBM). Its pathogenesis remains unclear. The authors evaluated the clinical and radiological factors associated with the onset of communicating hydrocephalus and the impact of ventriculoperitoneal (VP) shunt surgery on the outcome of these patients.

Methods

One hundred twenty-four patients harboring GBM, who had undergone craniotomy for tumor resection and adjuvant radiochemotherapy, were retrospectively assessed. Seven of them developed communicating hydrocephalus and were treated with VP shunt surgery. Clinical and radiological estimates included Karnofsky Performance Scale (KPS) score, previous surgery, overall survival (OS), CSF pressure and components, tumor location, and leptomeningeal dissemination.

Results

All 7 patients who developed communicating hydrocephalus had undergone at least 2 craniotomies for tumor resection before the onset of hydrocephalus (p = 0.0006; Fisher exact test). Six cases showed high levels of CSF proteins. There was a highly significant relationship between ventricular opening at surgery for tumor recurrence and onset of hydrocephalus (p = 0.0002; Fisher exact test). In these patients, VP shunt surgery was followed by a significant improvement of KPS score (p = 0.0180; Wilcoxon signed-rank test). The median OS after VP shunt insertion was 5 ± 2.9 months.

Conclusions

Ventricular opening after radiochemotherapy and high CSF protein levels are significant predictors of communicating hydrocephalus in patients with GBM. The VP shunt surgery improves quality of life in these patients.

Abbreviations used in this paper: GBM = glioblastoma multiforme; KPS = Karnofsky Performance Scale; OS = overall survival; VP = ventriculoperitoneal.
Article Information

Contributor Notes

Address correspondence to: Nicola Montano, M.D., Institute of Neurosurgery, Catholic University, Largo Agostino Gemelli, 8, 00168 Rome, Italy. email: nicolamontanomd@yahoo.it.Please include this information when citing this paper: published online September 9, 2011; DOI: 10.3171/2011.8.JNS11738.

© AANS, except where prohibited by US copyright law.

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References
  • 1

    Ando SMoritake K: Communicating hydrocephalus occurring in the postoperative course of glioblastoma multiforme. Nihon Geka Hokan 58:5085151989

    • Search Google Scholar
    • Export Citation
  • 2

    Chaichana KLHalthore ANParker SLOlivi AWeingart JDBrem H: Factors involved in maintaining prolonged functional independence following supratentorial glioblastoma resection. Clinical article. J Neurosurg 114:6046122011

    • Search Google Scholar
    • Export Citation
  • 3

    Inamasu JNakamura YSaito RKuroshima YMayanagi KOrii M: Postoperative communicating hydrocephalus in patients with supratentorial malignant glioma. Clin Neurol Neurosurg 106:9152003

    • Search Google Scholar
    • Export Citation
  • 4

    Lacroix MAbi-Said DFourney DRGokaslan ZLShi WDeMonte F: A multivariate analysis of 416 patients with glioblastoma multiforme: prognosis, extent of resection, and survival. J Neurosurg 95:1901982001

    • Search Google Scholar
    • Export Citation
  • 5

    Louis DNOhgaki HWiestler ODCavenee CW: WHO Classification of Tumours of the Central Nervous System ed 4LyonIARC Press2007. 3349

    • Search Google Scholar
    • Export Citation
  • 6

    Marquardt GSetzer MLang JSeifert V: Delayed hydrocephalus after resection of supratentorial malignant gliomas. Acta Neurochir (Wien) 144:2272312002

    • Search Google Scholar
    • Export Citation
  • 7

    Onda KTanaka RTakahashi HTakeda NIkuta F: Symptomatic cerebrospinal fluid dissemination of cerebral glioblastoma. Computed tomographic findings in 11 cases. Neuroradiology 32:1461501990

    • Search Google Scholar
    • Export Citation
  • 8

    Pallini RRicci-Vitiani LBanna GLSignore MLombardi DTodaro M: Cancer stem cell analysis and clinical outcome in patients with glioblastoma multiforme. Clin Cancer Res 14:820582122008

    • Search Google Scholar
    • Export Citation
  • 9

    Perrini PScollato ACioffi FMouchaty HConti RDi Lorenzo N: Radiation leukoencephalopathy associated with moderate hydrocephalus: intracranial pressure monitoring and results of ventriculoperitoneal shunting. Neurol Sci 23:2372412002

    • Search Google Scholar
    • Export Citation
  • 10

    Roth JConstantini SBlumenthal DTRam Z: The value of ventriculoperitoneal shunting in patients with glioblastoma multiforme and ventriculomegaly. Acta Neurochir (Wien) 150:41472008

    • Search Google Scholar
    • Export Citation
  • 11

    Smith KAAshby LSGonzalez LFBrachman DGThomas TCoons SW: Prospective trial of gross-total resection with Gliadel wafers followed by early postoperative Gamma Knife radiosurgery and conformal fractionated radiotherapy as the initial treatment for patients with radiographically suspected, newly diagnosed glioblastoma multiforme. J Neurosurg 109:Suppl1061172008. (Erratum in J Neurosurg 110:1323–1324 2009 and in J Neurosurg 111:639 2009)

    • Search Google Scholar
    • Export Citation
  • 12

    Stupp RMason WPvan den Bent MJWeller MFisher BTaphoorn MJB: Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. N Engl J Med 352:9879962005

    • Search Google Scholar
    • Export Citation
  • 13

    Thiessen BDeAngelis LM: Hydrocephalus in radiation leukoencephalopathy: results of ventriculoperitoneal shunting. Arch Neurol 55:7057101998

    • Search Google Scholar
    • Export Citation
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