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Risk Factors, Indications, and Effectiveness of Cerebrospinal Fluid Diversion in Patients With High-Grade

Jovanna A Tracz1,2, Max A Saint-Germain1, Cathleen C Kuo3

  • 1Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore , Maryland , USA.

Neurosurgery
|June 25, 2025
PubMed

Insights

Cerebrospinal fluid (CSF) diversion significantly improves symptoms and functional status in patients with high-grade glioma (HGG)-associated hydrocephalus. This procedure may be recommended when patient functionality and symptom relief are priorities.

Area of Science:

  • Neurosurgery
  • Oncology
  • Neurology

Background:

  • High-grade glioma (HGG) can lead to hydrocephalus, a condition requiring cerebrospinal fluid (CSF) diversion.
  • The role and effectiveness of CSF diversion in HGG patients with hydrocephalus remain debated.
  • This study systematically reviews evidence on CSF diversion for HGG-associated hydrocephalus.

Purpose of the Study:

  • To evaluate the effectiveness of CSF diversion in adult patients with HGG-associated hydrocephalus.
  • To assess improvements in patient survival, functional status (Karnofsky Performance Status - KPS), and symptoms.
  • To identify risk factors, indications, and complications associated with CSF diversion in this population.

Main Methods:

  • Systematic review and meta-analysis of studies identified through PubMed, SCOPUS, CINAHL, Cochrane, and Embase.
  • Inclusion of adult HGG patients with hydrocephalus who underwent CSF diversion.
  • Analysis of primary outcomes: symptomatic improvement, survival, and KPS; secondary outcomes: hydrocephalus risk and CSF diversion complications.

Main Results:

  • Hydrocephalus affects approximately 8% of HGG patients.
  • Common symptoms include cognitive decline, gait disturbance, and headache.
  • CSF diversion led to significant symptomatic improvement (79%) and a mean KPS increase of 15.04 points.
  • Median survival post-diversion was 4.7 months; complication rate was 28% without reported peritoneal seeding.

Conclusions:

  • CSF diversion offers significant benefits for symptom and functional improvement in HGG-associated hydrocephalus.
  • The procedure may be a valuable option when prioritizing patient functionality and symptom relief.
  • Further research may refine indications and management strategies for CSF diversion in HGG patients.
Abstract

Keywords:
Cerebrospinal fluid diversionHigh-grade gliomaHydrocephalusMalignant gliomaVentriculoperitoneal shunt

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