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Infratentorial complications following preresection CSF diversion in children with posterior fossa tumors

Mohamed Ali El-Gaidi1, Ashraf Hesham Abou El-Nasr, Ehab Mohamed Eissa

  • 1Department of Neurosurgery, Kasr Al-Aini Medical School, Cairo University, Cairo, Egypt.

Journal of Neurosurgery. Pediatrics
|November 8, 2014
PubMed

Insights

Infratentorial complications like intratumoral hemorrhage and upward transtentorial herniation occur in 2.3% of pediatric posterior fossa tumor surgeries following cerebrospinal fluid diversion. These complications have a poor prognosis, even with intervention.

Area of Science:

  • Pediatric Neurosurgery
  • Neuro-oncology
  • Surgical Complications

Background:

  • Posterior fossa tumors are common in children.
  • Cerebrospinal fluid (CSF) diversion is often necessary before tumor resection.
  • Infratentorial complications can arise after CSF diversion.

Purpose of the Study:

  • To determine the incidence and causes of infratentorial complications after CSF diversion in children with posterior fossa tumors.
  • To analyze the morbidity and mortality associated with these complications.

Main Methods:

  • Retrospective review of 437 pediatric patients with posterior fossa tumors (2005-2012).
  • Analysis of 301 patients who underwent CSF diversion (ventriculoperitoneal shunt or endoscopic third ventriculostomy) before resection.
  • Identification of infratentorial complications including intratumoral hemorrhage (ITH) and upward transtentorial herniation (UTH).

Main Results:

  • Seven children (2.3%) developed neurological deterioration due to infratentorial complications.
  • Ventriculoperitoneal shunt: 2.8% incidence (4 ITH, 2 UTH).
  • Endoscopic third ventriculostomy: 1.1% incidence (1 ITH).
  • Complications were more frequent with large tumors (≥ 4 cm), severe hydrocephalus, and peritumoral edema.

Conclusions:

  • Infratentorial complications are a significant risk (2.3%) following preresection CSF diversion in pediatric posterior fossa tumors.
  • These complications, including ITH and UTH, carry a very poor prognosis.
  • Early recognition and management are crucial, though outcomes remain challenging.
Abstract

Keywords:
CSF diversionETV = endoscopic third ventriculostomyEVD = external ventricular drainageICP = intracranial pressureITH = intratumoral hemorrhageUTH = upward transtentorial herniationVP = ventriculoperitonealhydrocephalusintratumoral hemorrhageposterior fossa tumorupward transtentorial herniation

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