Related Experiment Video
Updated: Aug 14, 2025
Author Spotlight: A Single-Entry Point Endoscopic Intraventricular Approach for Third Ventriculostomy and Pineal Biopsy
Published on: June 28, 2024
Perioperative external ventricular drainage vs. no-EVD strategy in pediatric posterior fossa tumors-pilot study
Matthias Krause1, Jürgen Meixensberger2, Hagen Graf von Einsiedel3
1Department of Neurosurgery, Pediatric Neurosurgery, University Hospital Leipzig, University Leipzig, Liebigstrasse 20, Leipzig, 04103, Germany. krause@neurosurgeon.ch.
Insights
Perioperative external ventricular drainage (EVD) in pediatric posterior fossa tumors did not improve hydrocephalus control. This approach increased the risk of needing permanent CSF diversion, suggesting a no-EVD strategy is safe and effective.
Area of Science:
- Pediatric Neurosurgery
- Hydrocephalus Management
- Neuro-oncology
Background:
- Posterior fossa pediatric brain tumors frequently cause obstructive hydrocephalus.
- Endoscopic third ventriculostomy (ETV) and ventriculoperitoneal shunting (VPS) are established treatments for hydrocephalus.
- The safety and efficacy of temporary external ventricular CSF drainage (EVD) in this context require further investigation.
Purpose of the Study:
- To evaluate the impact and safety of perioperative EVD placement on hydrocephalus outcomes in pediatric posterior fossa tumor patients.
- To compare the effectiveness of an EVD strategy versus a no-EVD strategy in managing postoperative hydrocephalus.
Main Methods:
- A prospective study included 36 pediatric patients (2-18 years) with posterior fossa tumors.
- Patients were categorized into non-hydrocephalus (Group I), hydrocephalus with EVD (Group IIa), and hydrocephalus without EVD (Group IIb).
- Outcomes were assessed based on pre- and postoperative MRI ventricular indices and need for permanent CSF diversion (ETV/VPS).
Main Results:
- Fifty-eight percent of patients presented with preoperative hydrocephalus.
- EVD placement did not demonstrate superior control of hydrocephalus compared to the no-EVD strategy, based on ventricular indices.
- Patients receiving perioperative EVD had a threefold increased risk of requiring subsequent permanent CSF diversion (ETV/VPS).
Conclusions:
- Perioperative EVD placement in pediatric posterior fossa tumor patients is associated with a significantly higher risk of requiring permanent CSF diversion.
- The no-EVD strategy was found to be safe and did not lead to adverse postoperative complications.
- Further prospective studies are warranted to validate these findings regarding EVD's impact on hydrocephalus outcomes.
Introduction:
Pediatric brain tumors of the posterior fossa often present with occlusive hydrocephalus. Endoscopic third ventriculostomy (ETV) or ventriculoperitoneal shunting (VPS) has been established for definite hydrocephalus treatment. The aim of the study was to analyze the impact and safety of perioperative temporary external ventricular CSF drainage (EVD) placement on postoperative hydrocephalus outcome compared to a no-EVD strategy.
Patients And Methods:
In a prospective database, 36 posterior fossa tumor patients of 2-18 years were included with a follow-up of 1 year. Fifty-eight percent presented with preoperative hydrocephalus. Patients were assigned to non-hydrocephalus group: group I (n = 15) and to preoperative hydrocephalus, group IIa with EVD placement (n = 9), and group IIb without EVD (n = 12).
Results:
Median age of patients was 8.1 years (range 3.17 to 16.58 years). One-third of 21 hydrocephalus patients required ETV or VPS (n = 7). Occurrence of de novo hydrocephalus in group I after surgery was not observed in our cohort. Age and histology were no confounding factor for EVD placement between group IIa and IIb (p = 0.34). The use of EVD did not result in better control of hydrocephalus compared to no-EVD patients considering pre- and postoperative MRI ventricular indices (p = 0.4). Perioperative placement of an EVD resulted in a threefold risk for subsequent VPS or ETV (group IIa 55.5% vs group IIb 16.6%): relative risk for EVD patients compared to no-EVD patients with hydrocephalus was 3.3 (CI = 1.06-13.43, p = 0.09).
Conclusion:
Perioperative EVD placement appears to harbor a threefold relative risk of requiring subsequent permanent CSF diversion in children above 2 years. EVD was not more effective to control ventricular enlargement compared to tumor removal alone. The no-EVD strategy was safe and did not result in postoperative complications. Thus, to evaluate potential adverse effects on hydrocephalus outcome by EVD placement, a prospective study is warranted to falsify the results.
More Related Videos
14:59Neuronavigation and Laparoscopy Guided Ventriculoperitoneal Shunt Insertion for the Treatment of Hydrocephalus
Published on: October 14, 2022
05:39Author Spotlight: A Non-Intubated Video-Assisted Thoracoscopic Surgery with Multimodal Analgesia and Sevoflurane Inhalation Anesthesia
Published on: May 26, 2023
