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. 2017 Sep 1;2(5):240–241. doi: 10.1016/j.pbj.2017.07.151

Evaluation of clinical characteristics as indicators for shunt procedure in patients with medulloblastoma

PS210

A Paunović 1,∗, F Milisavljević 1, J Bošković 1
PMCID: PMC6806795  PMID: 32258762

Aim: Determing clinical characteristics and parameters reliable as predictors of the need for the shunt installation and their relation to the treatment outcome.

Introduction: Medulloblastoma represents the most common pediatric tumor, that most frequently involves posterior cranial fossa and often manifests as hydrocephalus. Current therapy involves tumor excision and posterior cranial fossa decompression, with or without temporary external drainage of cerebrospinal fluid, endoscopic ventriculocisternostomy and ventriculoperitoneal (VP) shunt placement.

Methods: This retrospective study included 36 patients treated in the period from January 1st 2007 to December 31st 2015 in the Clinic of Neurosurgery, Clinical Center of Serbia. Basic demographic data, symptoms and signs at admission, degree of tumor resection and disease outcome information were analyzed.

Results: 22 patients (61.1%) were male and 14 (38.9%) were female, most of them 4–14 years old (58.3). Sex and age showed no significant corelation with VP shunt installation, or timing of shunt installation. VP shunt was installed in 92% of patients, in 33.3% prior to and in remaining after surgery. The most frequently observed symptoms on admission were cerebellar symptomatology (91.2%), headache (75.7%) and vomiting (68.5%), which showed no significant correlation with the VP shunt installation and shunt installation timing. In 83% of patients total resection was achieved. The degree of tumor resectability and VP shunt installation were significantly related (p<0.001). Correlation among shunt installation and treatment outcomes, as well as the shunt installation timing and outcome showed a statistical significance (p<0.001).

Conclusion: No clinical characteristics reliable as prognostic parameter for VP shunt installation in medulloblastoma patients have been found. Shunt placement is recommended in all cases of incomplete tumor resection, unless already placed preoperatively. Patients with a shunt placed prior to surgery have had significantly better outcome.1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35

References

  • 1.Lachi PK, Syed FAJD, Moinca I, et al. Medulloblastoma: a common pediatric tumor: prognostic factors and predictors of outcome. Asian J Neurosurg. 2015;10:50. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 2.Koeller KK, Rushing EJ. From the archives of the AFIP: medulloblastoma: a comprehensive review with radiologic-pathologic correlation. Radiographics. 2003;23:1613-1637. [DOI] [PubMed] [Google Scholar]
  • 3.Taylor MD, Northcott PA, Korshunov A, et al. Molecular subgroups of medulloblastoma: the current consensus. Acta Neuropathol. 2012;123:465-472. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 4.David NL, Arie P, Guido R, et al. The 2016 World Health Organization Classification of Tumors of the Central Nervous System: a summary. Acta Neuropathol. 2016;131:803-820. [DOI] [PubMed] [Google Scholar]
  • 5.Albright AL, Pollack IF, Adelson PD. 2014. Principles and practice of pediatric neurosurgery, 3rd ed. Thieme, New York. [Google Scholar]
  • 6.Thompson EM, Hielscher T, Bouffet E, et al. Prognostic value of medulloblastoma extent of resection after accounting for molecular subgroup: a retrospective integrated clinical and molecular analysis. Lancet Oncol. 2016;17:484-495. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 7.Nikitovic MR, Golubicic IV, Borojevic ND, et al. Pediatric brain tumors-diagnostic and treatment. Acta Chir Iugosl. 2009;56:19-24. [DOI] [PubMed] [Google Scholar]
  • 8.Nikitovic MR, Golubicic IV. Treatment options for childhood medulloblastoma. Vojnosanit Pregl. 2013;70:773-777. [DOI] [PubMed] [Google Scholar]
  • 9.Fatema M, Ira JD. Treatment approach for recurrent medulloblastoma. Clin Insights: Opt Therapy Pediatr Medulloblastoma. 2015;59-73. [Google Scholar]
  • 10.Pilkington G, Walker D. Guidelines on the diagnosis and management of Adult PNETs. Br Neuro-Oncol Soc/NCAT Rare Tumour Guidelines 2011. [Google Scholar]
  • 11.Handler MH, Callahan B. Laparoscopic placement of distal ventriculoperitoneal shunt catheters. J Neurosurg Pediatr. 2008;2:282-285. [DOI] [PubMed] [Google Scholar]
  • 12.Naftel RP, Argo JL, Shannon CN, et al. Laparoscopic versus open insertion of the peritoneal catheter in ventriculoperitoneal shunt placement: review of 810 consecutive cases. J Neurosurg. 2011;115:151-158. [DOI] [PubMed] [Google Scholar]
  • 13.Roth J, Sagie B, Szold A, Elran H. Laparoscopic versus non-laparoscopic-assisted ventriculoperitoneal shunt placement in adults. A retrospective analysis. Surg Neurol. 2007;68:177-184. [DOI] [PubMed] [Google Scholar]
  • 14.Pettersson D, Schmitz KR, Jeffrey M, et al. Medulloblastoma: seeding of VP shunt tract and peritoneum. Clin Pract. 2012;2:e37. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 15.Jennett B, Bond M. Assessment of outcome after severe brain damage. Lancet. 1975;7905:480-484. [DOI] [PubMed] [Google Scholar]
  • 16.Culley DJ, Berger MS, Shaw D, et al. An analysis of factors determining the need for ventriculoperitoneal shunts after posterior fossa tumor surgery in children. Neurosurgery. 1994;34:402-407. [discussion 407–8]. [DOI] [PubMed] [Google Scholar]
  • 17.Riva-Cambrin J, Detsky AS, Lamberti-Pasculli M, et al. Predicting postresection hydrocephalus in pediatric patients with posterior fossa tumors. J Neurosurg Pediatr. 2009;3:378-385. [DOI] [PubMed] [Google Scholar]
  • 18.Albright L, Reigel DH. Management of hydrocephalus secondary to posterior fossa tumors. J Neurosurg. 1977;46:52-55. [DOI] [PubMed] [Google Scholar]
  • 19.Raimondi AJ, Tomita T. Hydrocephalus and infratentorial tumors. Incidecence, clinical picture and treatment. J Neurosurg. 1981;55:174-182. [DOI] [PubMed] [Google Scholar]
  • 20.Hekmatpanah J, Mullan S. Ventriculo-caval shunt in the menagement of posterios fossa tumors. J Neurosurg. 1967;26:609-613. [DOI] [PubMed] [Google Scholar]
  • 21.Schneider C, Ramaswamy V, Kulkarni AV, et al. Clinical implication of medulloblastoma subgroups: incidence of CSF diversion surgery. J Neurosurg Pediatr. 2014;1-7. [DOI] [PubMed] [Google Scholar]
  • 22.Foreman P, McClugage S, Naftel R, et al. Validation and modification of a predictive model of postresection hydrocephalus in pediatric patients with posterior fossa tumors. J Neurosurg Pediatr. 2013;12:220-226. [DOI] [PubMed] [Google Scholar]
  • 23.Morelli D, Pirotte B, Lubansu A, et al. Persistent hydrocephalus after early surgical management of posterios fossa tumors in children:is routine preoperative endoscopic third ventriculostomy justified? J Neurosurg. 2005;103:247-252. [DOI] [PubMed] [Google Scholar]
  • 24.Gnanalingham KK, Lafuente J, Thompson D, et al. The natural history of ventriculomegaly and tonsilar herniation in children with posterios fossa tumours-an MRI study. Pediatr Neurosurg. 2003;39:246-253. [DOI] [PubMed] [Google Scholar]
  • 25.Sainte-Rose C, Cinalli G, Roux FE, et al. Management of hydrocephalus in pediatric patients with posterios fossa tumors: the role of endoscopic thirs ventriculostomy. J Neurosurg. 2001;95:791-797. [DOI] [PubMed] [Google Scholar]
  • 26.Tamburrini G, Pettorini BL, Massimi L, et al. Endoscopic third ventriculostomy: the best option in the treatment of persistent hydrocephalus after posterior cranial fossa tumour removal? Childs Nerv Syst. 2008;24:1405-1412. [DOI] [PubMed] [Google Scholar]
  • 27.Tuli S, Tuli J, Drake J, et al. Predictors of death in pediatric patients requiring cerebrospinal fluid shunts. J Neurosurg. 2004;100:442-446. [DOI] [PubMed] [Google Scholar]
  • 28.Drake JM, Kestle JRW, Milner R, et al. Randomized trial of cerebrospinal fluid shunt valve design in pediatric hydrocephalus. Neurosurgery. 1998;43:294. [DOI] [PubMed] [Google Scholar]
  • 29.Cochrane DD, Kestle JRW. The influence of surgical operative experience on the duration of first ventriculoperitoneal shunt function and infection. Pediatr Neurosurg. 2003;38:295-301. [DOI] [PubMed] [Google Scholar]
  • 30.McLaurin RL. Disadvantages of the preoperative shunt in posterios fossa tumors. Clin Neurosurg. 1983;30:286-292. [DOI] [PubMed] [Google Scholar]
  • 31.Taylor WA, Todd NV, Leighton SE. CSF drainage in patients with posterios fossa tumours. Acta Neurochir(Wien). 1992;117:1-6. [DOI] [PubMed] [Google Scholar]
  • 32.Di Rocco F, Juca CE, Zerah M, et al. Endoscopic third ventriculostomy and posterior fossa tumors. WNEU. 2013;79:S18.e15-S18.e19. [DOI] [PubMed] [Google Scholar]
  • 33.Bouras T, Sgouros S. Complications of endoscopic third ventriculostomy. J Neurosurg Pediatr. 2011;7:643-649. [DOI] [PubMed] [Google Scholar]
  • 34.Kulkarni AV, Drake JM, Mallucci Cl, et al. Endoscopic third ventriculostomy in the treatment of childhood hydrocephalus. J Pediatr. 2009;155:254-259. [DOI] [PubMed] [Google Scholar]
  • 35.Drake JM. Canadian Pediatric Neurosurgery Study Group. Endoscopic third ventriculostomy in pediatric patients: the Canadian experience. Neurosurgery. 2007;60:881-886. [DOI] [PubMed] [Google Scholar]

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