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60th Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Benelux countries and Bulgaria

German Society of Neurosurgery (DGNC)

24 - 27 May 2009, Münster

Treatment of occlusive hydrocephalus in patients with tumours of the pineal region

Meeting Abstract

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  • P. Emami - Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Hamburg-Eppendorf
  • M. Westphal - Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Hamburg-Eppendorf

Deutsche Gesellschaft für Neurochirurgie. 60. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit den Benelux-Ländern und Bulgarien. Münster, 24.-27.05.2009. Düsseldorf: German Medical Science GMS Publishing House; 2009. DocMO.15-05

doi: 10.3205/09dgnc106, urn:nbn:de:0183-09dgnc1068

Published: May 20, 2009

© 2009 Emami et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



From 1981 to 2007 we treated 95 patients suffering from tumours of the pineal region by surgery. In 71 cases, an occlusive hydrocephalus was one of the initial clinical findings. We focused retrospectively on the treatment of this specific symptom.

68 patients were treated by some kind of drainage of the CSF. There were a total number of 93 operations including revisions.

36 of these patients underwent an acute treatment of hydrocephalus initially (42 operations): 19 shunts, 17 external ventricular drainages (EVD) and 6 cases of 3rd ventriculostomies.After the tumour operation, 27 patients were still operated: 14 shunts, 8 EVDs and 5 cases of 3rd ventriculostomy.

From 1985 to 1990, we implanted an external drainage in 95% of cases during the main operation, half of them were shunted after the tumour resection. In 38% we even performed permanent shuntings before the tumour operation. From 1991 to 2007 only 52% of patients (14 cases) had an EVD intraoperatively, just 2 of them (14%) were shunted later. Only 9% were primarily shunted.

Among the 32 patients, who needed permanent shuntings, 17 had total or gross total resection of the tumour; in 15 cases the tumour was biopsied or subtotally removed. 29% of patients with a total or gross total resection were permanently shunted, as well as 54% of the biopsied or partially removed cases.

In the 1980s we only implanted ventriculo-atrial shunts, while we now regularly implant ventriculo-peritoneal shunts since 1990.

In most cases the best way to treat an occlusive hydrocephalus is the total removal of the tumour, although close to 1/3 of these patients still require permanent shunting. Intraoperative implantation of EVDs probably does not diminish the risk of persistent hydrocephalus in the long run.