gms | German Medical Science

Objective: Gliomas are the most common primary brain tumors. Maximum extent of tumor resection is one of the most important predictors of overall survival, irrespective of histological or molecular subtype or tumor grade. However, aggressive resection can lead to ventricular opening, potentially increasing the risk for development of communicating hydrocephalus (CH). Complications such as rebleeding and infection may also lead to CH and, eventually, the need for cerebrospinal fluid (CSF) diversion surgery. In this study, we evaluated potential risk factors for the development of postoperative CH in glioma patients.

Methods: 1165 patients that underwent glioma resection (WHO grade I: 6,2% of patients; II: 13,1%; III: 17,3%; IV: 63,4%) at our department between 2006 and 2019 were analysed retrospectively. Potential risk factors that were determined for each patient were age, sex, tumor WHO grade, the number of resection surgeries, ventricular opening during resection, postoperative CSF leak, ventriculitis, and rebleeding. Uni- as well as multivariate analyses were performed to identify statistically significant risk factors using the free R software environment.

Results: 90 of 1165 (7.7%) patients had CSF diversion surgery (implantation of a ventriculoperitoneal or ventriculoatrial shunt) after glioma resection surgery at, on average, postoperative day 27 (median; mean: 98; range: 0-3531 days). 16 patients had obstructive hydrocephalus and 74 patients had CH. Of these, 66.2% had a grade IV tumor (grade III: 21.6%; II: 5.4%; I: 6.8%). The number of resection surgeries (p=0.005867), ventricular opening (p=0.000162; odds ratio: 5.1), ventriculitis (p=0.000153; OR: 3.1), CSF leak (p=0.0139; OR: 2.2), and rebleeding (p=0.017; OR: 2.3) were identified as significant independent risk factors for development of postoperative CH. Age, sex or WHO grade were not associated with postoperative CH.

Conclusion: Postoperative CH treated by CSF shunting is frequent in glioma surgery. This may be due to the paradigm shift towards intensified treatment regimes in recent years: CH may be a late consequence of the tumor itself that is seen more frequently with more patients surviving longer. On the other hand, it also appears to be influenced by treatment-related factors. If preoperative risk factors (i.e., a high number of resection surgeries, mandatory ventricular opening) are present, one should discuss the possibility of postoperative CH with the patient and maybe even consider pre-emptive shunt implantation.