Prognostic Factors for Shunting in Medulloblastoma Combined with Hydrocephalus

ABSTRACT

The majority of patients with medulloblastoma present with hydrocephalus. It has been reported, however, that not all medulloblastoma patients will continue to have hydrocephalus after the tumor is resected, and in fact, only selected patients need permanent shunts. To retrospectively identify the prognostic factors indicating this requirement, we analysed several charateristics in patients without preoperative shunts suffering from medulloblastoma combined with hydrocephalus. We studied 32 patients and divided them into two groups those requiring shunts within 4 weeks of surgery, and those not shunted. Nine patients(28%) required a permanent shunt. We found that these patients were younger(4.8+/-4.3 vs. 9.6+/-7.4 years; p<0.05), had more extensive tumors (Chang's stage T2 vs. T3; p<0.050), and that postoperatively, some tumor remained(p<0.05). However, with regard to gender, symptoms of increasedintracranial pressure(ICP), the duration of these symptoms, positive cerebrospinal fluid(CSF) cytology, perioperative external ventricular drainage, and degree of preoperative hydrocephalus, there were no differences between the groups. It was thus concluded that younger patients with extensive preoperative tumors and tumors remaining after surgery may benefit from postoperative CSF diversion. It was thought that patients not fitting the above criteria can probably be managed with perioperative corticosteroids alone.