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Updated: Jul 21, 2025

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Postoperative Communicating Hydrocephalus Following Grade 2/3 Glioma Resection: Incidence, Timing and Risk Factors.

Lisa S Hönikl1, Nicole Lange1, Bernhard Meyer1

  • 1Department of Neurosurgery, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany.

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|July 29, 2023
PubMed
Summary

Communicating hydrocephalus (CH) requiring cerebrospinal fluid (CSF) diversion surgery occurs in 6.9% of patients after glioma resection. Grade 3 gliomas, rebleeding, and ventriculitis are key risk factors for developing CH post-surgery.

Keywords:
cerebrospinal fluid shuntgliomahydrocephaluspostoperativerisk factors

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Area of Science:

  • Neurosurgery
  • Oncology
  • Neuropathology

Background:

  • Extent of tumor resection is crucial for survival in diffuse gliomas.
  • Post-glioblastoma (WHO grade 4) resection, complications like ventriculitis can lead to communicating hydrocephalus (CH) requiring cerebrospinal fluid (CSF) diversion.
  • Risk factors for CH after lower-grade glioma resection are less understood.

Purpose of the Study:

  • To determine the incidence and timing of hydrocephalus after grade 2 and 3 glioma resection.
  • To identify independent risk factors for developing CH post-resection in these patients.

Main Methods:

  • Retrospective analysis of 346 patients undergoing glioma resection (WHO grade 2 and 3) between 2006 and 2019.
  • Evaluation of patient data including demographics, tumor characteristics, surgical events (ventricular opening, ventriculitis, rebleeding), and outcomes.
  • Uni- and multivariate statistical analyses to identify risk factors for CH.

Main Results:

  • 6.9% of patients required CSF diversion surgery post-resection.
  • Communicating hydrocephalus (CH) occurred in 5.5% of patients, with a median onset of 44 days post-resection.
  • WHO grade 3, rebleeding, ventriculitis, and infratentorial tumor location were significant independent risk factors for CH.

Conclusions:

  • Postoperative CH requiring CSF shunting is a risk after lower-grade glioma resection, particularly for grade 3 tumors.
  • CH typically manifests several weeks after surgery.
  • Rebleeding and postoperative ventriculitis are significant independent risk factors for CH development.