Vastani Amisha, Baig Mirza Asfand, Ali Fizza, Iqbal Allayna, Sharma Chaitanya, Khizar Khoja Abbas, Vaqas Babar, Lavrador José Pedro, Pollock Jonathan
Department of Neurosurgery, Queens Hospital, Romford, UK.
GKT School of Medical Education, King's College London, London, UK.
Neurooncol Pract. 2024 Jun 20;11(6):703-712. doi: 10.1093/nop/npae055. eCollection 2024 Dec.
Posterior fossa tumors (PFTs) comprise 15%-20% of adult brain tumors, with the reported frequency of hydrocephalus (HCP) ranging between 3.7% and 58%. Most HCP resolves after resection of PFTs, but studies report persistent or new-onset HCP occurring in between 2% and 7% of cases. Preoperative cerebrospinal fluid (CSF) diversion with a ventriculoperitoneal shunt (VPS), external ventricular drain (EVD), or endoscopic third ventriculostomy (ETV) has been shown to improve outcomes. Evidence regarding the efficacy of these techniques is limited.
A systematic literature search was performed in line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Data points were extracted from individual patient cohort data. A failure rate was determined by the number of patients requiring further postoperative CSF diversion.
In total, 8863 records were identified. Thirteen studies consisting of 17 patient cohorts met our inclusion criteria. Across all individual cohort studies, 2976 patients underwent surgical resection of a PFT in whom the frequency of hydrocephalus at presentation was 22.98% (1.92%-100%), and persistent hydrocephalus following preoperative CSF diversion was 13.63% (0%-18%). Of the 684 hydrocephalic patients, 83.63% underwent CSF diversion in the form of ETV, EVD, or VPS. Between years 1992 and 2020, 1986 and 2021, and 1981and 2013, the pre-resection ETV, EVD, and VPS failure rates were 14.66% (17/116), 16.26% (60/369), and 0% (0/87), respectively.
This systematic review highlights that VPS has a better failure rate profile in minimizing postoperative hydrocephalus in adult patients with PFTs.
后颅窝肿瘤（PFTs）占成人大脑肿瘤的15%-20%，报道的脑积水（HCP）发生率在3.7%至58%之间。大多数脑积水在PFTs切除后得到缓解，但研究报告称，2%至7%的病例会出现持续性或新发脑积水。术前通过脑室腹腔分流术（VPS）、脑室外引流（EVD）或内镜下第三脑室造瘘术（ETV）进行脑脊液（CSF）分流已被证明可改善治疗效果。关于这些技术疗效的证据有限。
按照系统评价和Meta分析的首选报告项目进行系统文献检索。从个体患者队列数据中提取数据点。失败率由术后需要进一步进行CSF分流的患者数量确定。
共识别出8863条记录。13项研究（包括17个患者队列）符合我们的纳入标准。在所有个体队列研究中，2976例患者接受了PFTs手术切除，其中就诊时脑积水的发生率为22.98%（1.92%-100%），术前CSF分流后持续性脑积水的发生率为13.63%（0%-18%）。在684例脑积水患者中，83.63%接受了ETV、EVD或VPS形式的CSF分流。在1992年至2020年、1986年至2021年以及1981年至2013年期间，切除术前ETV、EVD和VPS的失败率分别为14.66%（17/116）、16.26%（60/369）和0%（0/87）。
本系统评价强调，在将成年PFTs患者术后脑积水降至最低方面，VPS的失败率情况更佳。
