Evaluation of cerebrospinal fluid diversion procedures in treatment of pediatric midline posterior fossa tumors

ABSTRACT

Neurosurgeons still divided in their opinions concerning the best way to manage obstructive hydrocephalus secondary to posterior fossa tumors. Some authors proposed a preoperative indwelling cerebrospinal fluid shunt as the most advantageous method for the subsequent surgical approach to the tumor. Others proposed direct approach to the posterior fossa tumor, when possible, or external ventricular drainage, when necessary. This study aimed to evaluate the role of cerebrospinal fluid diversion procedures in treatment of hydrocephalus due to midline posterior fossa tumors in children. Eighty-eight patients were included in this retrospective study. They were classified into two groups 22 patients operated for direct tumour attack without CSF diversion and 66 patients operated for CSF diversion before tumour attack. The later group was further subdivided into three subgroups according to the method of CSF diversion; V-P shunt, ETV, and EVD. This study carried out in the Neurosurgery Department, at Suez Canal University Hospital in the period between March 1995 and February 2005. The use of CSF diversion procedure was associated with improvement of hydrocephalus in 70% of patients while direct tumour attack was associated with improvement of hydrocephalus in 31% of patients. The best results were found in ventriculoperitoneal shunt [100%] followed by endoscopic third ventriculostomy [60%] then the external ventricular drainage [31%].The use of CSF diversion is beneficial in treatment of hydrocephalus due to midline posterior fossa tumour in children