Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Department of Neural Reconstruction, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.
Neurosurg Rev. 2023 Sep 18;46(1):246. doi: 10.1007/s10143-023-02156-4.
Post-operative hydrocephalus is common among children with medulloblastoma after initial tumor resection. This study aimed to establish a novel model for predicting the development of post-operative hydrocephalus in children with medulloblastoma. Only pediatric patients who received initial medulloblastoma resection at Beijing Tiantan Hospital between January 2018 and May 2021 were included in this study. The potential risk factors associated with post-operative hydrocephalus were identified based on multivariate logistic regression and the nomogram. Receiver operating characteristic (ROC) curve were used to evaluate the performance of the nomogram model based on an independent cohort of medulloblastoma patients who underwent surgery from June 2021 to March 2022. A total of 105 patients were included in the primary cohort. Superior invasion (P = 0.007), caudal invasion (P = 0.025), and intraventricular blood ≥ 5 mm (P = 0.045) were significantly related to the development of post-operative hydrocephalus and thus were assembled into the nomogram model. The model accurately predicted post-operative hydrocephalus based on the calibration curve. The area under the ROC curves for the primary and validation cohorts was 0.849 and 0.855, respectively. In total, the nomogram we developed may aid clinicians in assessing the potential risk of pediatric patients with MB developing post-operative hydrocephalus, especially those who would otherwise not have received a diversionary procedure at presentation.
术后脑积水是儿童髓母细胞瘤初始肿瘤切除后常见的并发症。本研究旨在建立一种预测儿童髓母细胞瘤术后脑积水发展的新模型。本研究仅纳入 2018 年 1 月至 2021 年 5 月期间在北京天坛医院接受初始髓母细胞瘤切除术的儿科患者。基于多变量逻辑回归和列线图确定与术后脑积水相关的潜在危险因素。使用接受手术的髓母细胞瘤患者的独立队列（2021 年 6 月至 2022 年 3 月）来评估基于列线图模型的接收者操作特征（ROC）曲线的性能。共有 105 例患者纳入主要队列。研究结果表明，肿瘤向上方（P = 0.007）、向下方（P = 0.025）和向脑室内部侵犯（P = 0.045）与术后脑积水的发生显著相关，因此将这些因素纳入列线图模型。该模型基于校准曲线准确预测术后脑积水。ROC 曲线在主要队列和验证队列中的 AUC 分别为 0.849 和 0.855。总之，我们开发的列线图可能有助于临床医生评估儿科患者发生术后脑积水的潜在风险，特别是那些在就诊时未接受分流手术的患者。
