Management of hydrocephalus in children with medulloblastoma: Prognostic factors for shunting

Mark Lee, Jeffrey H. Wisoff, Rick Abbott, Diana Freed, Fred J. Epstein

Research output: Contribution to journalArticle

60 Scopus citations

Abstract

Patients with medulloblastoma frequently present with hydrocephalus. While not all patients with medulloblastoma will continue to suffer from hydrocephalus after tumor resection, there is a significant proportion who will require a permanent shunt. We have retrospectively reviewed a group of children with medulloblastoma not shunted preoperatively, and have identified several characteristics which are associated with a requirement for permanent shunt. We studied 42 patients and found that 17 patients (40%) required permanent shunts within 4 weeks of craniotomy. The shunted patients were younger (5.4 ± 2.9 vs. 10.0 ± 5.7 years; p < 0.01), had larger ventricles (p < 0.05), and had more extensive tumors (Chang’s stage T3 and T4; p < 0.01). These variables were all independently significant. In addition, we found that the patients requiring postcraniotomy shunts had a much higher rate of morbidity including a postoperative pseudobulbar syndrome. Of interest, we found that none of our patients without the above characteristics required a shunt. In particular, we found that no patient older than 10 years required a shunt. Thus, we conclude that younger patients with moderate to severe preoperative hydrocephalus and extensive tumors may benefit from perioperative CSF diversion. Other patients not meeting the above criteria can probably be safely managed with perioperative corticosteroids alone.

Original languageEnglish (US)
Pages (from-to)240-247
Number of pages8
JournalPediatric neurosurgery
Volume20
Issue number4
DOIs
StatePublished - Jan 1 1994
Externally publishedYes

Keywords

  • Complications
  • Hydrocephalus
  • Medulloblastoma
  • Posterior fossa tumors
  • Postoperative
  • Primitive neuroectodermal tumor
  • Pseudobulbar palsy
  • Shunt

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Surgery
  • Clinical Neurology

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