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Updated: Aug 19, 2026
Neuronavigation and Laparoscopy Guided Ventriculoperitoneal Shunt Insertion for the Treatment of Hydrocephalus
Published on: October 14, 2022
Abdominal metastases of pediatric brain tumors via ventriculo-peritoneal shunts
1Institute of Neuropathology, Westfälische Wilhelms-Universität, Münster, Germany.
Insights
Ventriculo-peritoneal shunts (VPS) can spread pediatric brain tumors to the abdomen. While rare, these metastases impact survival, with a better prognosis in boys and adolescents.
Area of Science:
- Neuro-oncology
- Pediatric Neurosurgery
- Cancer Metastasis
Background:
- Obstructive hydrocephalus in children is often treated with ventriculo-peritoneal shunts (VPS).
- VPS, as an artificial pathway, can facilitate the spread of cerebrospinal fluid (CSF) containing tumor cells.
- VPS-related abdominal metastases represent a rare but significant complication of pediatric brain tumors.
Purpose of the Study:
- To review and analyze cases of abdominal metastases secondary to pediatric brain tumors treated with VPS.
- To identify the incidence, common tumor types, and prognostic factors associated with VPS-related metastases.
Main Methods:
- A comprehensive literature review was conducted to identify relevant studies.
- Data on patient demographics, tumor types, shunt details, metastasis diagnosis, and survival outcomes were extracted and analyzed.
- Patients were stratified by age (0-9 years and 10-18 years) and sex.
Main Results:
- Thirty-five cases of VPS-related abdominal metastases were identified.
- Germinomas, medulloblastomas, endodermal sinus tumors, and astrocytomas were the most common primary tumors.
- The overall mortality rate was 73.3%, with a mean survival of 18.7 months post-shunting.
- Metastases were more frequent in males and in the second decade of life, with a more favorable prognosis in these groups.
Conclusions:
- VPS-related abdominal metastases are a rare but serious complication in pediatric brain tumor patients.
- Early consideration of this metastatic pathway is crucial for diagnosis and management.
- Prognosis appears more favorable for male patients and those in the second decade of life.
Abstract:
Internal drainage of cerebrospinal fluid (CSF) to the abdominal cavity via a ventriculo-peritoneal shunt (VPS) is a procedure that is commonly used for the treatment of obstructive hydrocephalus. As this condition is often caused by brain tumors blocking the natural CSF pathways, a VPS, as an artificial anastomosis, can provide the means for tumor cells to be spread with the CSF. A review of the literature reveals 35 VPS-related abdominal metastases from pediatric brain tumors; 17 in patients aged 0-9 (group A) and 18 in patients aged 10-18 years (group B); the mean age of male patients was 10.5, and that of female patients, 7 years. The male-to-female ratio was 1.9 (group A 1.1, group B 3.5), and the mean interval between shunt operation and diagnosis of metastases, 16.7 months (group A 11.6, group B 22.6 months; boys 21.6, girls 7.5 months). During the observation period, 22/30=73.3% of the patients died (group A 13/15=86.7%, group B 9/15=60%; boys 13/21=61.9%, girls 9/9=100%); their mean survival time after shunting was 18.7 months (group A 15.7, group B 23.1 months; boys 25.5, girls 9 months). The four most common sources of metastases were germinomas (9 cases=25.7%; group A none, group B 9), medulloblastomas (8 cases=22.9%, group A 7, group B 1), endodermal sinus tumors (5 cases=14.3%, group A 1, group B 4), and astrocytomas (4 cases=11.4%, group A 4, group B none). Metastases via VPS are rare, but should be considered as a possible complication and mode of systemic spread in children with primary intracranial malignancy. They have a more favorable prognosis in boys and in the second decade of life.
