Object Approximately 30% of children with posterior fossa tumors exhibit hydrocephalus after tumor resection. Recent literature has suggested that prophylactic endoscopic third ventriculostomy diminishes the risk of this event. Because the majority of patients will not have postoperative hydrocephalus, a preoperative clinical prediction rule that identifies patients at high or low risk for postresection hydrocephalus would be helpful to optimize the care of these children. Methods The authors evaluated a derivation cohort of 343 consecutive children with posterior fossa tumors who underwent treatment between 1989 and 2003. Multivariate methods were used on these data to generate the Canadian Preoperative Prediction Rule for Hydrocephalus. The rule's estimated risk of postresection hydrocephalus was compared with risk observed in 111 independent patients in the validation cohort. Results Variables identified as significant in predicting postresection hydrocephalus were age < 2 years (score of 3), papillede...

Predicting postresection hydrocephalus in pediatric patients with posterior fossa tumors.

Objective: The majority of children with posterior fossa tumors have hydrocephalus (HC) at the time of presentation. There is no consensus regarding the management of HC in these ch

Management of Hydrocephalus in Children with Posterior Fossa Tumors: Role of Tumor Surgery

Object
The authors analyze the factors that predispose to persistent hydrocephalus in children with posterior fossa tumors and compare their results and treatment policy with those described in the literature, particularly with regard to the higher postoperative shunt insertion rates, which have led some authors to the routine use of preoperative third ventriculostomy.

Analysis of CSF shunting procedure requirement in children with posterior fossa tumors.

Object Controversy exists regarding the indication for endoscopic third ventriculostomy (ETV) in children with hydrocephalus caused by posterior fossa tumors. The authors present their treatment modalities and discuss the role of ETV in the management of hydrocephalus. Methods The authors retrospectively reviewed the cases of 58 children who were admitted to their clinic consecutively with posterior fossa tumors between January 1999 and December 2003. Fifty-two patients presented with hydrocephalus. The mean age at the time of admission was 6 years and 3 months. The mean follow-up period was 25 months. The authors evaluated how many children required a cerebrospinal fluid (CSF) draining procedure (external ventricular drain [EVD], ventriculoperitoneal [VP] shunt, or ETV) prior to or following tumor removal. Only six patients (11.5%) required permanent treatment for hydrocephalus. Four patients received a VP shunt and two patients underwent ETV. A temporary EVD was placed in five patients (two required a s...

Hydrocephalus in children with posterior fossa tumors: role of endoscopic third ventriculostomy.

Background: No consensus exists regarding the management of hydrocephalus in children with posterior fossa tumors before, during or after surgery. In the present

Factors predicting the need for cerebrospinal fluid diversion following posterior fossa tumor surgery in children.

The authors reviewed 175 paediatric patients with posterior fossa tumours treated at the Hospital for Sick Children at Great Ormond Street, London, between 1983 and 1993, in an attempt to determine the requirement for shunt procedures in these children. The age of the patient population ranged from 4 months to 14 years 6 months. The factors evaluated included age at diagnosis, tumour type, extent of surgical resection, and the presence of CSF leak and/or infection. Shunt placement was required postoperatively in 18.9% of patients. Age of the patient was felt to be a significant factor in the need for shunt placement. Tumour type and completeness of tumour excision were also felt to be significant factors affecting the need for post-operative shunt insertion.

Ventriculo-peritoneal shunt requirement in children with posterior fossa tumours: an 11-year audit

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Ventriculo-peritoneal shunt requirement in children with posterior fossa tumours: an 11-year audit