Cerebrospinal Fluid Diversion Procedures in Children with Posterior Fossa Tumors: Ventriculoperitoneal Shunt Versus Endoscopic Third Ventriculostomy Versus External Ventricular Drainage

Treatment of hydrocephalus in posterior fossa tumors in children is still a matter of controversy and different centers have their own routines. In this regard, hospital records of all children with posterior fossa tumors treated in Children s Cancer Hospital Egypt, during the interval of 2008-2011 were reviewed. Patients demographic and diagnostic data were analyzed and the frequencies of cerebrospinal fluid diversion procedures were determined. Exact test was employed to compare the frequency of postoperative complications in different groups. A total of 170 patients with age ranging from 3 months to 18 years and a male to female ratio of 1.5 comprised the study population. 161 cases had hydrocephalus at the time of diagnosis and 81 patients underwent preoperative shunting and 62 patients underwent endoscopic third ventriculostomy (ETV). Of the remaining 18 patients, 13 underwent external ventricular drainage at tumor operation session plus preoperative corticosteroid therapy. The rest of the patients got no primary treatment for hydrocephalus. Three of these 5 patients had postoperative shunting after tumor removal, but the other 2 remained shunt free. The rate of postoperative complications including cerebrospinal fluid leakage and septic meningitis were significantly lower in patients with preoperative shunting and ETV. The results of this study are in favor of those that approve the effect of preoperative shunting or ETV in decreasing postoperative complications. This is well established when the tumor size is big or when the diagnosis of posterior fossa tumor is made in later stages or when hydrocephalus is severe. It could be concluded that preoperative shunting or ETV can decrease the rate of postoperative complications. ETV also minimizes the risk of over drainage because it provides more physiological CSF drainage than the other procedures and avoids the complications of shunting procedures.