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Risk Factors of Persistent Hydrocephalus in Children with Brain Tumor: A Retrospective Analysis
Chiara Pilotto1,2, Ilaria Liguoro1,2, Serena Scaravetti1
1Department of Medicine, DAME, University of Udine, Udine, Italy.
Insights
Pediatric brain tumor patients with an Evans' index >0.34 or fronto-occipital horn ratio >0.46 before surgery are more likely to need persistent hydrocephalus treatment. Early identification aids in planning cerebrospinal fluid drain devices.
Area of Science:
- Pediatric neuro-oncology
- Neurosurgery
- Pediatric neurology
Background:
- Hydrocephalus is a common complication in pediatric brain tumors, affecting approximately 50% of cases at diagnosis and persisting post-surgery in 10-40% of children.
- Persistent hydrocephalus requires timely intervention, often involving cerebrospinal fluid (CSF) drain devices, to manage increased intracranial pressure and prevent neurological damage.
Purpose of the Study:
- To identify predictive variables for the need for treatment of persistent hydrocephalus in pediatric patients diagnosed with brain tumors.
- To improve preoperative assessment and planning for CSF management in this vulnerable population.
Main Methods:
- Retrospective review of 43 pediatric patients with newly diagnosed brain tumors.
- Preoperative and postoperative MRI scans were analyzed to calculate Evans' index (EI) and fronto-occipital horn ratio (FOHR).
- Logistic regression was used to assess the association between EI, FOHR, and persistent hydrocephalus requiring intervention.
Main Results:
- Hydrocephalus was present preoperatively in 51% of patients (22/43).
- Postoperative hydrocephalus persisted in 36% of those who underwent tumor resection (8/22).
- Preoperative EI >0.34 and FOHR >0.46 were significantly associated with persistent hydrocephalus and the need for CSF drain devices.
Conclusions:
- Preoperative EI and FOHR measurements can help identify pediatric brain tumor patients at risk for persistent hydrocephalus.
- These findings can guide proactive planning for CSF drain device placement, potentially avoiding treatment delays.
- Further prospective, larger-scale studies are recommended to standardize this predictive approach.
Object:
Hydrocephalus is one of the main complications of brain tumors in children, being present in about 50% of cases at the time of the tumor diagnosis and persisting up to 10-40% of cases after surgical resection. This is a single-institution retrospective study on the variables that may predict the need for treatment of persistent hydrocephalus in pediatric patients presenting with a brain tumor.
Methods:
Retrospective case note review of 43 newly diagnosed brain tumors in children referred between April 2012 and January 2018 to our regional pediatric neuro-oncology service was carried out. Diagnosis of hydrocephalus was carried out using both preoperative and postoperative MRI to determine Evans' index (EI) and the fronto-occipital horn ratio (FOHR) from each scan. Simple logistic regression was used to analyze categorical variables as appropriate. A p value <0.05 was considered significant.
Results:
Forty-three children were analyzed, 26 males and 17 females with a median age at diagnosis 10.4 years (IQR: 5.2-13.5). Hydrocephalus was present in 22/43 children (51%) preoperatively; in 8/22 children (36%) with hydrocephalus undergoing tumor resection, hydrocephalus persisted also in the postoperative period. An EI >0.34 (p = 0.028) and an FOHR >0.46 (p = 0.05) before surgery were associated with a higher prevalence of persistent hydrocephalus and therefore to the need for a cerebrospinal fluid drain device in the postoperative phase.
Conclusion:
Preoperative identification of children at risk for developing persistent hydrocephalus would avoid delays in planning the permanent cerebrospinal fluid drain devices. This study finds that an EI >0.34 and an FOHR >0.46 at diagnosis could impact on the therapeutic management of children with hydrocephalus associated with brain tumors. Prospective and larger-scale studies are needed to standardize this approach.
