Department of Neurosurgery, Devadoss Hospital, Madurai - 625 020, Tamil Nadu, India.
Neurol India. 2021 Nov-Dec;69(Supplement):S342-S349. doi: 10.4103/0028-3886.332260.
Hydrocephalus associated with posterior fossa tumor (PFT) is a common neurosurgical problem, the management of which is still controversial.
To provide an overview of the advantages and limitations of different management strategies for hydrocephalus associated with PFT both before and after resection of these tumors.
Structured review of the literature on the management of hydrocephalus in PFT both in children and adults.
The incidence of hydrocephalus associated with PFT at the time of presentation is more in children (70-90%) than adults (10-21%). This difference is maintained for hydrocephalus after the resection of PFT (~30% for children and 1.2-6.9% for adults). Preresection hydrocephalus is obstructive while emerging evidence in the literature suggests that postresection hydrocephalus may have a communicating component. The treatment of preresection hydrocephalus associated with PFT has undergone a paradigm shift in the past two decades. Preoperative Cerebrospinal Fluid (CSF) diversion is less commonly used except when required by the clinical condition of the patient. Preresection hydrocephalus may be treated by steroid use and early tumor removal, perioperative use of external ventricular drainage, or endoscopic third ventriculostomy in selected patients. Various prediction scales are available to assess the risk of postresection hydrocephalus in PFT. Certain histological tumor types and molecular phenotypes of PFT are more commonly associated with hydrocephalus. CSF diversion through endoscopic third ventriculostomy or ventriculoperitoneal shunts remains the management strategies for postresection hydrocephalus. The failure rates and the time-to-failure of both endoscopic third ventriculostomy and CSF shunts in PFT are variable and surgeons should be aware of these while taking management decisions.
Hydrocephalus associated with PFT affects the quality of life of patients with such lesions. Routine preoperative CSF diversion is not necessary for the vast majority of patients with posterior fossa tumor-related hydrocephalus. A high index of suspicion and aggressive surveillance is required for the early identification and appropriate management of postresection hydrocephalus. Future studies are needed to address several unanswered questions pertaining to the management of this condition.
后颅窝肿瘤（PFT）相关脑积水是一种常见的神经外科问题，其管理仍存在争议。
提供 PFT 切除前后不同脑积水管理策略的优缺点概述。
对儿童和成人 PFT 相关脑积水管理的文献进行系统回顾。
PFT 就诊时脑积水的发生率在儿童中（70-90%）高于成人（10-21%）。这种差异在后颅窝肿瘤切除后仍存在（儿童约 30%，成人 1.2-6.9%）。术前脑积水为梗阻性，而文献中的新证据表明，术后脑积水可能具有交通性成分。过去二十年，PFT 相关术前脑积水的治疗发生了范式转变。术前脑脊液（CSF）分流术的应用较少，除非患者的临床状况需要。术前脑积水可通过使用类固醇和早期肿瘤切除、围手术期使用外部脑室引流或在选定患者中进行内镜第三脑室造口术来治疗。有多种预测量表可用于评估 PFT 术后脑积水的风险。某些组织学肿瘤类型和 PFT 的分子表型更常与脑积水相关。通过内镜第三脑室造口术或脑室-腹腔分流术进行 CSF 分流仍然是 PFT 术后脑积水的治疗策略。内镜第三脑室造口术和 CSF 分流术在 PFT 中的失败率和失败时间各不相同，外科医生在做出治疗决策时应注意这些因素。
PFT 相关脑积水影响此类病变患者的生活质量。对于绝大多数与后颅窝肿瘤相关的脑积水患者，常规术前 CSF 分流不是必需的。需要高度怀疑并积极监测，以便早期发现和适当处理术后脑积水。需要进一步研究来解决与该疾病管理相关的几个未解答的问题。
