gms | German Medical Science

Objective: Cerebrospinal fluid (CSF) pathway obstruction may occur in patients treated for glioblastoma. The benefit and disadvantage of CSF shunting into the peritoneal space under such circumstances remains unclear. In this study, we analyzed retrospectively the occurrence and the role of CSF shunting in a consecutive series of patients with glioblastoma treated surgically in our institution.

Method: The medical records of patients, who underwent CSF shunting related to glioblastoma between January 2002 and September 2013 were analyzed retrospectively. Data included the patient’s treatment history, including surgical interventions, radiochemotherapy regimens, clinical findings, CSF findings for biochemical parameters and cytology, postoperative complications, and survival rate.

Results: Among 469 patients, who had undergone craniotomy for tumor resection of glioblastoma, 22 patients (mean age 45.68±24.46 years) underwent CSF shunting due to occlusion hydrocephalus (n=5), malresorptive hydrocephalus (n=12), persistent subdural hygroma (n=3), and trapped CSF in resection cavities (n=2). Neither abnormal CSF protein elevations nor tumor cells were detected in CSF. Procedures performed included ventriculoperitoneal shunt (n=17), subduroperitoneal shunt (n=3), and cystoperitoneal shunt (n=2). CSF shunting was performed prior to (18.2%, n=4) or after (81.8%, n=18) tumor resection. Shunt revision was necessary in 31.8% of patients (single revision, n=4; multiple revisions, n=3) due to catheter obstruction, catheter dislocation, overdrainage, valve deficiency, and infection. Nineteen patients died due to disease progression during the follow-up time. Two patients are still alive and one patient was lost to follow-up. The median Karnofsky Performance Scores (KPS) before and after CSF shunting was 70%. The median overall survival time was 8.72 months.

Conclusions: The need for CSF shunting in patients with glioblastoma is infrequent. CSF shunting does not prolong survival time, nevertheless, a temporary improvement of neurological deterioration may enhance quality-of-life in most patients and might eventually enable patients to undergo further treatment. Shunt-related complications in patients with glioblastoma seem to be relatively high, but can usually be managed by revision surgery. Although CSF shunting is accompanied by relatively frequent complications in patients with glioblastoma, it provides amelioration and stabilisation of the patient’s clinical state.