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Choroid Plexus Cauterization Prevents Postoperative Hydrocephalus in Adult Glioblastoma Resection With Ventricular
Stuart D Harper1, Amani Carson1, Jacob A Alderete1
1Department of Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA.
Insights
Choroid plexus cauterization (CPC) effectively prevents postoperative hydrocephalus after glioblastoma resection with ventricular entry. This safe procedure reduces hospital readmissions and improves patient outcomes, offering a critical intervention for this patient group.
Area of Science:
- Neurosurgery
- Oncology
- Pediatric Neurosurgery
Background:
- Glioblastoma resection often involves ventricular entry, increasing hydrocephalus risk.
- Postoperative hydrocephalus negatively impacts patient readmissions, hospital stays, and functional status.
- The efficacy of choroid plexus cauterization (CPC) in preventing hydrocephalus post-glioblastoma resection is not well-established.
Purpose of the Study:
- To evaluate the safety and efficacy of CPC in preventing postoperative hydrocephalus following glioblastoma resection with ventricular entry.
- To characterize the impact of hydrocephalus on patient outcomes, including survival and functional status.
Main Methods:
- Historical cohort analysis of 260 patients undergoing glioblastoma resection with ventricular entry.
- Prospective evaluation of CPC in a matched cohort with ventricular entry.
- Quantification of choroid plexus volume reduction via MRI segmentation post-CPC.
Main Results:
- 25.8% of patients developed postoperative hydrocephalus, associated with increased readmissions and longer hospital stays.
- Prospective CPC showed no procedure-related complications and a 50% reduction in choroid plexus volume.
- CPC significantly reduced postoperative hydrocephalus rates (3.3% vs 25.8%) and hospital readmissions.
Conclusions:
- Postoperative hydrocephalus following glioblastoma resection with ventricular entry necessitates preventative strategies.
- CPC is a safe and effective adjunct for preventing hydrocephalus, reducing readmissions, and improving outcomes.
- CPC is crucial for improving the quality of life for glioblastoma patients with limited survival expectations.
Background And Objectives:
Glioblastoma often extends along the subventricular zone and resection frequently results in ventricular entry, which is associated with increased risk of postoperative hydrocephalus. Choroid plexus cauterization (CPC) is a treatment for pediatric hydrocephalus, but its utility in preventing postoperative hydrocephalus following glioblastoma resection with ventricular entry is unknown. We sought to characterize CPC safety and efficacy in preventing postoperative hydrocephalus in this setting.
Methods:
We evaluated a historical cohort of 260 patients who underwent craniotomy for glioblastoma with ventricular entry, assessing postoperative hydrocephalus, survival, and functional outcomes. Furthermore, we prospectively performed CPC in a matched cohort with ventricular entry. We quantitated the volume of choroid plexus that was successfully cauterized using magnetic resonance segmentation and evaluated the safety and efficacy of CPC.
Results:
25.8% of patients with glioblastoma resection with ventricular entry developed postoperative hydrocephalus. Hydrocephalus was associated with more readmissions (2.3 vs 0.6; P < .0001), longer hospital stays (10.0 vs 6.5 days; P = .0047), and lower 3-month Karnofsky Performance Status (64.4 vs 78.6; P < .0001), although overall survival was unaffected. Thirty patients underwent prospective CPC with no procedure-related postoperative complications. Choroid plexus volume in the involved ventricle decreased by 50% on postoperative MRI segmentations (P = .0020). In a matched analysis, there was a reduction in postoperative hydrocephalus compared with the retrospective cohort (3.3% vs 25.8%; P = .0060) associated with fewer hospital readmissions (P = .0330).
Conclusion:
As ventricular entry becomes increasingly common during supramaximal glioblastoma resection, our data demonstrate that patients who develop postoperative hydrocephalus have more readmissions, longer hospital stays, and worse functional status. Thus, strategies to reduce postoperative hydrocephalus are critical. Although it does not alter the natural course of glioblastoma itself, we find that CPC represents a safe and effective adjunct that prevents postoperative hydrocephalus, reduces hospital readmissions, and downstream interventions, which is extremely important to a patient cohort with limited expected survival.
