gms | German Medical Science

Background: Preoperative obstructive hydrocephalus in patients with posterior fossa tumors is frequently seen. Treatment options include immediate tumor removal or prior CSF diversion procedures. Additionally, some patients require further treatment of hydrocephalus after tumor surgery. We report our experience with special regard to ETV done prior to tumor removal in adults.

Materials and methods: We reviewed our prospectively maintained database for ETV´s due to tumor related hydrocephalus in adults from 1993 to 2014. Initially 109 patients were found. In 36.7% (n=40) of the cases tumors were located in the posterior fossa and ETV was performed either before or after surgery of these tumors.

Results: 24 female and 16 male patients were included in the study (mean age 55.4 years). MR imaging revealed an enlargement of supratentorial ventricles in every patient. In 92.5% of patients (n=37) ETV was done prior to tumor surgery. Mean time before tumor surgery was 15 days. Hydrocephalic symptoms improved after ETV in all patients. In three patients (7.5%) ETV was performed after tumor removal and persisting hydrocephalus. Mean follow up for 32 patients was 73.5 months. Four patients were lost to follow up. Four patients died during the postoperative course after tumor removal for several reasons. There were no complications related to ETV. None of the patients required further VP shunting. Three early Re-ETV´s had to be performed.

Conclusion: ETV constitutes an effective treatment of symptomatic hydrocephalus prior to posterior fossa tumor removal in adults. If hydrocephalus becomes symptomatic even after tumor surgery ETV is recommended and VP shunting can be avoided.