Ventriculomegaly and postoperative lateral/third ventricular blood as predictors of cerebrospinal fluid diversion following posterior fossa tumor resection

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  • 1 Department of Neurosurgery, Duke University Medical Center, Durham;
  • | 2 Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham;
  • | 3 Preston Robert Tisch Brain Tumor Center, Duke University, Durham, North Carolina; and
  • | 4 Department of Neurosurgery, Westchester Medical Center, Valhalla, New York
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OBJECTIVE

Postoperative hydrocephalus occurs in one-third of children after posterior fossa tumor resection. Although models to predict the need for CSF diversion after resection exist for preoperative variables, it is unknown which postoperative variables predict the need for CSF diversion. In this study, the authors sought to determine the clinical and radiographic predictors for CSF diversion in children following posterior fossa tumor resection.

METHODS

This was a retrospective cohort study involving patients ≤ 18 years of age who underwent resection of a primary posterior fossa tumor between 2000 and 2018. The primary outcome was the need for CSF diversion 6 months after surgery. Candidate predictors for CSF diversion including age, race, sex, frontal occipital horn ratio (FOHR), tumor type, tumor volume and location, transependymal edema, papilledema, presence of postoperative intraventricular blood, and residual tumor were evaluated using a best subset selection method with logistic regression.

RESULTS

Of the 63 included patients, 26 (41.3%) had CSF diversion at 6 months. Patients who required CSF diversion had a higher median FOHR (0.5 vs 0.4) and a higher percentage of postoperative intraventricular blood (30.8% vs 2.7%) compared with those who did not. A 0.1-unit increase in FOHR or intraventricular blood was associated with increased odds of CSF diversion (OR 2.9 [95% CI 1.3–7.8], p = 0.02 and OR 20.2 [95% CI 2.9–423.1], p = 0.01, respectively) with an overfitting-corrected concordance index of 0.68 (95% CI 0.56–0.80).

CONCLUSIONS

The preoperative FOHR and postoperative intraventricular blood were significant predictors of the need for permanent CSF diversion within 6 months after posterior fossa tumor resection in children.

ABBREVIATIONS

AIC = Akaike information criterion; c-index = concordance index; CPPRH = Canadian Preoperative Prediction Rule for Hydrocephalus; ETV = endoscopic third ventriculostomy; EVD = external ventricular drain; FHR = frontal horn ratio; FOHR = frontal occipital horn ratio; GOF = goodness of fit; RBC = red blood cell; ROC = receiver operating characteristic; VPS = ventriculoperitoneal shunt.

Illustration from Soleman et al. (pp 544–552). Copyright Lucille Solomon.

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