Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China.
PLoS One. 2020 Nov 17;15(11):e0241853. doi: 10.1371/journal.pone.0241853. eCollection 2020.
Most patients who present with a fourth ventricle tumor have concurrent hydrocephalus, and some demonstrate persistent hydrocephalus after tumor resection. There is still no consensus on the management of hydrocephalus in patients with fourth ventricle tumor after surgery. The purpose of this study was to identify the factors that predispose to postoperative hydrocephalus and the need for a postoperative cerebrospinal fluid (CSF) diversion procedure.
We performed a retrospective analysis of patients who underwent surgery of the fourth ventricle tumor between January 2013 and December 2018 at the Department of Neurosurgery in West China Hospital of Sichuan University. The characteristics of patients and the tumor location, tumor size, tumor histology, and preventive external ventricular drainage (EVD) that were potentially correlated with CSF circulation were evaluated in univariate and multivariate analysis.
A total of 121 patients were enrolled in our study; 16 (12.9%) patients underwent postoperative CSF drainage. Univariate analysis revealed that superior extension (p = 0.004), preoperative hydrocephalus (p<0.001), and subtotal resection (p<0.001) were significantly associated with postoperative hydrocephalus. Multivariate analysis revealed that superior extension (p = 0.013; OR = 44.761; 95% CI 2.235-896.310) and subtotal resection (p = 0.005; OR = 0.087; 95% CI 0.016-0.473) were independent risk factors for postoperative hydrocephalus after resection of fourth ventricle tumor.
Superior tumor extension (into the aqueduct) and failed total resection of tumor were identified as independent risk factors for postoperative hydrocephalus in patients with fourth ventricle tumor.
大多数表现为第四脑室肿瘤的患者同时伴有脑积水，一些患者在肿瘤切除后仍存在持续性脑积水。对于第四脑室肿瘤患者术后脑积水的处理，目前仍无共识。本研究旨在确定哪些因素易导致术后脑积水，以及是否需要进行术后脑脊液（CSF）分流术。
我们对 2013 年 1 月至 2018 年 12 月在四川大学华西医院神经外科接受第四脑室肿瘤手术的患者进行了回顾性分析。对患者的特征以及肿瘤位置、肿瘤大小、肿瘤组织学和潜在与 CSF 循环相关的预防性外部脑室引流（EVD）进行了单因素和多因素分析。
共纳入 121 例患者，其中 16 例（12.9%）患者术后行 CSF 引流。单因素分析显示，肿瘤向上延伸（p = 0.004）、术前脑积水（p<0.001）和肿瘤次全切除（p<0.001）与术后脑积水显著相关。多因素分析显示，肿瘤向上延伸（p = 0.013；OR = 44.761；95% CI 2.235-896.310）和肿瘤次全切除（p = 0.005；OR = 0.087；95% CI 0.016-0.473）是第四脑室肿瘤切除术后发生术后脑积水的独立危险因素。
肿瘤向上延伸（进入导水管）和肿瘤未能完全切除是第四脑室肿瘤患者术后发生脑积水的独立危险因素。
