Artikel
Complete resection of posterior fossa tumors as effective first-line treatment of obstructive hydrocephalus in children
Suche in Medline nach
Autoren
-
F. Volz
- Klinik für Neurochirurgie, Universitätsklinikum Freiburg
-
R. Korinthenberg
- Klinik Neuropädiatrie und Muskelerkrankungen, Universitätsklinikum Freiburg
-
V. van Velthoven
- Klinik für Neurochirurgie, Universitätsklinikum Freiburg
| Veröffentlicht: | 4. Juni 2012 |
|---|
Gliederung
Text
Objective: Children suffering from posterior fossa tumors often present with symptoms of elevated intracranial pressure like headache, vomiting, VIth nerve palsy or deterioration of consciousness. Options for treatment of hydrocephalus caused by aqueductal obstruction are endoscopic third ventriculostomy (ETV), extraventricular drainage (EVD), VP-Shunt or early resection of the causing lesion. Some reports in literature claim that CSF drainage prior to the tumor operation reduces the risk of persisting hydrocephalus. We demonstrate that early surgical removal of the tumor alone avoids the supplementary intervention and does not increase the risk of postoperative shunt necessity.
Methods: We retrospectively analyzed our series of children with posterior fossa tumors.
Results: Between 2001 and 2010, 50 patients between 5 months and 18 years with tumor suspect lesions in the infratentorial space were treated in our department. All patients presented with some symptoms of increased intracranial pressure, 33 (73%) had radiological signs of hydrocephalus (Evan's index [EI] >0.3). Retrospectively, tumors were composed of pilocytic astrocytomas (n=25), medulloblastomas (n=7), ependymomas (n=6), teratomas (n=2) and other entities. 5 patients (10%) received preoperative CSF deviation due to practical or logistic reasons: 2 with ETV, followed by tumor resection, 2 with EVD followed by tumor resection and 1 patient received an ETV and implantation of a VP-shunt before tumor resection. In 45 patients early tumor resection without preoperative CSF drainage was performed. 40 of them (89%) had decreasing clinical and radiological signs of hydrocephalus and no need for further operative intervention. Only 5 patients (11%) had persistence of hydrocephalus and needed a second operation VP-shunt implantation.
Conclusions: We conclude that early surgical removal of posterior fossa tumors is effective in treating the concurrent obstructive hydrocephalus. The need of permanent CSF drainage is low and a second operation can mostly be avoided.
