Kraus Luisa Mona, Goldberg Maria, Ursu Eugen, Demirbag Kayra, Backhaus Simon Paul, Altawalbeh Ghaith, Bernhardt Denise, Negwer Chiara, Combs Stephanie, Meyer Bernhard, Wagner Arthur
Department of Neurosurgery, School of Medicine and Health, Klinikum Rechts Der Isar, University Hospital of TUM, Ismaninger Strasse 22, 81675, Munich, Germany.
Faculty of Medicine, Marmara University, Istanbul, Turkey.
J Neurooncol. 2025 Jun 23. doi: 10.1007/s11060-025-05125-7.
Infratentorial brain metastases (BM), particularly those causing obstruction of the fourth ventricle, are associated with a significant risk of postoperative hydrocephalus. This complication remains poorly understood, especially regarding its predictors beyond mechanical obstruction. This study aims to identify clinical predictors of postoperative hydrocephalus in patients undergoing surgery for infratentorial BM.
We performed a single-center retrospective analysis of 235 adult patients surgically treated for infratentorial BM between 2009 and 2025. Patients with leptomeningeal disease were excluded. Pre- and postoperative hydrocephalus were defined based on imaging and clinical criteria. Logistic regression and multivariate modeling were used to evaluate predictors, including clinical presentation, treatment history, and imaging features.
Postoperative hydrocephalus occurred in 18.45% of patients. Breast cancer patients exhibited the highest incidence (30.61%), significantly more than those with lung cancer (15.66%, p = 0.042). Preoperative hydrocephalus (p = 0.005), and prior chemotherapy (p = 0.001) or radiotherapy (p = 0.004) were significantly associated with postoperative hydrocephalus. Imaging variables, including tumor volume or proximity to the fourth ventricle, were not predictive. Multivariate regression confirmed preoperative hydrocephalus, and systemic treatment as independent risk factors.
Postoperative hydrocephalus in infratentorial BM is influenced not only by mechanical factors but also by preoperative clinical and therapeutic variables. Breast cancer patients, particularly those who received prior systemic or local therapy, are at higher risk. These findings suggest the need for individualized risk assessment and raise the question of whether prophylactic interventions could mitigate complications and treatment delays in high-risk cohorts.
幕下脑转移瘤（BM），尤其是那些导致第四脑室梗阻的肿瘤，与术后脑积水的显著风险相关。这种并发症仍未得到充分理解，特别是在机械性梗阻之外的预测因素方面。本研究旨在确定幕下BM手术患者术后脑积水的临床预测因素。
我们对2009年至2025年间接受幕下BM手术治疗的235例成年患者进行了单中心回顾性分析。排除有软脑膜疾病的患者。根据影像学和临床标准定义术前和术后脑积水。采用逻辑回归和多变量建模来评估预测因素，包括临床表现、治疗史和影像学特征。
18.45%的患者发生了术后脑积水。乳腺癌患者的发生率最高（30.61%），显著高于肺癌患者（15.66%，p = 0.042）。术前脑积水（p = 0.005）、既往化疗（p = 0.001）或放疗（p = 0.004）与术后脑积水显著相关。包括肿瘤体积或与第四脑室的接近程度在内的影像学变量并无预测价值。多变量回归证实术前脑积水和全身治疗是独立的危险因素。
幕下BM术后脑积水不仅受机械因素影响，还受术前临床和治疗变量影响。乳腺癌患者，尤其是那些接受过既往全身或局部治疗的患者，风险更高。这些发现表明需要进行个体化风险评估，并提出了预防性干预是否可以减轻高危人群并发症和治疗延迟的问题。
