Department of Medicine, DAME, University of Udine, Udine, Italy.
Pediatric Clinic, ASUIUD S Maria Della Misericordia, University Hospital, Udine, Italy.
Pediatr Neurosurg. 2021;56(3):205-212. doi: 10.1159/000513732. Epub 2021 Mar 30.
Hydrocephalus is one of the main complications of brain tumors in children, being present in about 50% of cases at the time of the tumor diagnosis and persisting up to 10-40% of cases after surgical resection. This is a single-institution retrospective study on the variables that may predict the need for treatment of persistent hydrocephalus in pediatric patients presenting with a brain tumor.
Retrospective case note review of 43 newly diagnosed brain tumors in children referred between April 2012 and January 2018 to our regional pediatric neuro-oncology service was carried out. Diagnosis of hydrocephalus was carried out using both preoperative and postoperative MRI to determine Evans' index (EI) and the fronto-occipital horn ratio (FOHR) from each scan. Simple logistic regression was used to analyze categorical variables as appropriate. A p value <0.05 was considered significant.
Forty-three children were analyzed, 26 males and 17 females with a median age at diagnosis 10.4 years (IQR: 5.2-13.5). Hydrocephalus was present in 22/43 children (51%) preoperatively; in 8/22 children (36%) with hydrocephalus undergoing tumor resection, hydrocephalus persisted also in the postoperative period. An EI >0.34 (p = 0.028) and an FOHR >0.46 (p = 0.05) before surgery were associated with a higher prevalence of persistent hydrocephalus and therefore to the need for a cerebrospinal fluid drain device in the postoperative phase.
Preoperative identification of children at risk for developing persistent hydrocephalus would avoid delays in planning the permanent cerebrospinal fluid drain devices. This study finds that an EI >0.34 and an FOHR >0.46 at diagnosis could impact on the therapeutic management of children with hydrocephalus associated with brain tumors. Prospective and larger-scale studies are needed to standardize this approach.
脑积水是儿童脑肿瘤的主要并发症之一，约 50%的病例在肿瘤诊断时存在，在手术切除后仍有 10-40%的病例存在。本研究是一项单中心回顾性研究，旨在探讨可能预测儿童脑肿瘤患者术后持续性脑积水需要治疗的变量。
对 2012 年 4 月至 2018 年 1 月期间我院小儿神经肿瘤专科收治的 43 例新诊断脑肿瘤患儿的病历进行回顾性分析。采用术前和术后 MRI 测量 Evans 指数（EI）和额枕角比（FOHR）来诊断脑积水。适当采用简单逻辑回归分析分类变量。p 值<0.05 为差异有统计学意义。
43 例患儿中，男 26 例，女 17 例，中位诊断年龄为 10.4 岁（IQR：5.2-13.5）。术前脑积水 22/43 例（51%）；22 例脑积水患儿中 8 例行肿瘤切除术，术后仍有脑积水。术前 EI>0.34（p=0.028）和 FOHR>0.46（p=0.05）与持续性脑积水的发生率较高相关，因此需要在术后阶段使用脑脊液引流装置。
术前识别有发生持续性脑积水风险的儿童，可以避免在计划永久性脑脊液引流装置时出现延误。本研究发现，诊断时 EI>0.34 和 FOHR>0.46 可能影响伴有脑肿瘤的脑积水儿童的治疗管理。需要前瞻性和更大规模的研究来规范这种方法。
