Wilhelmy Florian, Güresir Erdem, Wach Johannes, Vychopen Martin, Nestler Ulf, Prasse Gordian, Haddad Lisa, Kasper Johannes, Wende Tim
Department of Neurosurgery, University Hospital Leipzig, Leipzig, Germany.
Division of Neuroradiology, University Hospital Leipzig, Leipzig, Germany.
Sci Rep. 2025 Jun 20;15(1):20235. doi: 10.1038/s41598-025-06825-w.
Posterior fossa (PF) tumors are the most common neoplastic entity in pediatric neurosurgery. Children suffering from PF tumors regularly present with hydrocephalus and CSF diversion is a crucial point of treatment. There is an ongoing debate about external ventricular drainage (EVD) management before surgery and its influence on ongoing hydrocephalus treatment afterwards. Beyond onco-surgical aspects, the prevention of shunt-dependency is an important goal in posterior fossa surgery. Various predictors for shunt-dependency after posterior fossa surgery in children have been suggested. Because these predictors may only apply to small subsets of children, and their reliability has been questioned, we evaluated a straightforward, potentially automated, and unbiased method for shunt prediction. In this retrospective radiomic study we analyzed 60 pediatric patients with posterior fossa tumors. Exclusion criteria were age under two years, missing MRI data, tumor location non-exclusive to the PF, traumatic brain injury and less than 6 months follow-up. Ultimately, 36 children met the inclusion criteria. We performed a volumetric assessment of various skull and brain compartments before and after surgery focused on ventricle-brain ratio (VBR). We dichotomized for potential predictors and performed ROC analyses. We evaluated the prognostic parameters for shunt dependency, including supratentorial transependymal edema and VBR, as well as pre- and postoperative radiomic measurements as early prognostic tools. The cutoff in ventricle volume for CSF diversion was 60.9 ml (AUC 0.788, p = 0.001). The radiomic-based prediction of shunt dependency with VBR-scoring showed an AUC of 0.783. Postoperative reduction in ventricle size, depicted by the deltaVBR scoring, showed an AUC of 0.719 in predicting shunt-free survival. Perioperative CSF diversion did correlate with postoperative persistent HCP, whereas the odd's ratio for shunting was decreased, but not significantly lower, when CSF diversion was undertaken perioperatively (AUC = 0.618, OR = 0.273, CI = 0.029-2.577). Ventricle-brain ratio may be a potential predictor for the necessity of CSF diversion. In our cohort, radiomic predictors performed better than hydrocephalus categorization, modified Canadian Preoperative Prediction Rule for Hydrocephalus (mCPPRH) or transependymal edema alone. VBR pre- and deltaVBR postoperatively may be potential tools to predict the need for shunting in pediatric posterior fossa tumor patients. The decision for pre- or intraoperative CSF diversion showed no correlation and no influence on persistent hydrocephalus.
后颅窝（PF）肿瘤是小儿神经外科最常见的肿瘤类型。患有PF肿瘤的儿童经常出现脑积水，脑脊液分流是治疗的关键环节。关于术前外部脑室引流（EVD）管理及其对后续脑积水治疗的影响，目前仍存在争议。除了肿瘤手术方面，预防分流依赖是后颅窝手术的一个重要目标。已经提出了多种儿童后颅窝手术后分流依赖的预测指标。由于这些预测指标可能仅适用于一小部分儿童，且其可靠性受到质疑，我们评估了一种直接、可能自动化且无偏差的分流预测方法。在这项回顾性放射组学研究中，我们分析了60例患有后颅窝肿瘤的儿科患者。排除标准为年龄小于2岁、MRI数据缺失、肿瘤位置不局限于PF、创伤性脑损伤以及随访时间少于6个月。最终，36名儿童符合纳入标准。我们对手术前后各种颅骨和脑腔进行了容积评估，重点是脑室脑比（VBR）。我们将潜在预测指标进行二分法并进行ROC分析。我们评估了分流依赖的预后参数，包括幕上跨室管膜水肿和VBR，以及术前和术后的放射组学测量结果作为早期预后工具。脑脊液分流的脑室容积临界值为60.9 ml（AUC 0.788，p = 0.001）。基于放射组学的VBR评分对分流依赖的预测显示AUC为0.783。用deltaVBR评分描述的术后脑室大小减小，在预测无分流生存方面显示AUC为0.719。围手术期脑脊液分流与术后持续性脑积水确实相关，而当围手术期进行脑脊液分流时，分流的优势比降低，但没有显著降低（AUC = 0.618，OR = 0.273，CI = 0.029 - 2.577）。脑室脑比可能是脑脊液分流必要性的一个潜在预测指标。在我们的队列中，放射组学预测指标比脑积水分类、改良的加拿大术前脑积水预测规则（mCPPRH）或单独的跨室管膜水肿表现更好。术前VBR和术后deltaVBR可能是预测小儿后颅窝肿瘤患者分流需求的潜在工具。术前或术中脑脊液分流的决策与持续性脑积水无相关性且无影响。
