Artikel
Hydrocephalus in supratentorial glioblastoma – risk factors, indications and outcome
Hydrocephalus bei supratentoriellen Glioblastomen – Risikofaktoren, Indikationen und Outcome
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Veröffentlicht: | 4. Juni 2021 |
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Gliederung
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Objective: Glioblastoma is the most common adult primary CNS tumor and is marked by a challenging treatment. Modern treatment strategies have improved the overall prognosis however with a clinical course often scattered by treatment side effects and cognitive decline. Some patients present with clinical and radiological evidence of hydrocephalus either obstructive or communicating. The aim of our study was to investigate the incidence of hydrocephalus, risksfactors and treatment in a contemporary 10 years cohort of GBM patients.
Methods: We performed a retrospective review of glioblastoma patients treated and operated at least one time at our institution (Department of Neurosurgery, Medical Center – University of Freiburg) from 2009 to 2019. We identified a subgroup of 46 patients presenting with glioblastoma accompanied by symptomatic hydrocephalus treated by ventriculo-peritioneal (VP) or ventriculo-atrial (VA) shunt. Demographics, clinical characteristics, radiological features were analyzed and descriptive statistics as well as Fisher exact tests were performed.
Results: Of the 46 patients who underwent shunting, 42 (91.2 %) had a communicating hydrocephalus (CH), 4 (8.6%) an obstructive hydrocephalus (OH). In the subgroup of patients with CH opening of the ventricular system [Office1] during a previous surgery was present in 34 of 46 patients and identified as a risk factor (Fisher’s exact test p<0.05). There was also a trend toward location (frontal and temporal) and the volume of the tumor. Number of craniotomies before shunting was also considered as a risk factor (Fisher’s exact test p<0.05).
Hydrocephalus symptoms improved in 95% of the patients. Infection, over/under-drainage were the most common complications encountered requiring a shunt revision in thirteen patients of forty-six (28%). Thirteen patients needed a revision surgery, of whom five patients (10.9%) had an early complication (<30 days) and eight (17.5%) a late complication which needed arevision surgery. No peritoneal metastasis were found.
Conclusion: Ventricular system opening, number of craniotomies, and volume of the tumor were identified as risks factors for hydrocephalus in the context of a GBM. However, treatment of hydrocephalus in the context of a glioblastoma is challenging but improves symptoms in most of the patients and may therefore be considered even in palliative setting for relieve of symptoms.