Abstract
Objective Obstructive hydrocephalus in patients with posterior fossa tumors is frequently seen.
Treatment options include immediate tumor removal or prior cerebrospinal fluid (CSF)
diversion procedures. The necessity and feasibility of an ETV in these situations
has not yet been proven in adult patients.
Methods We retrospectively reviewed our prospectively maintained database for ETVs before
surgery of posterior fossa tumors in adults. The primary focus of data analyses was
the question of whether the ETV was suitable to treat the acute situation of hydrocephalus
without an increased rate of complications due to the special anatomical situation
with a posterior fossa tumor. We also analyzed whether any further CSF diverting procedures
were necessary.
Results A total of 40 adult patients who underwent an ETV before posterior fossa tumor surgery
were analyzed. Overall, 33 patients (82.5%) had clinical signs of hydrocephalus, and
all of them improved in their clinical course after ETV. Seven patients (17.5%) did
not demonstrate clinical signs of hydrocephalus, but ETV was performed with prophylactic
or palliative intent in six patients and one patient, respectively. No complications
were observed due to ETV itself. No permanent shunting procedure was necessary in
a mean follow-up of 76.5 months. Early additional CSF diverting procedures (redo ETV,
external ventricular drain) were performed in five patients (12.5%).
Conclusion The present series confirms the feasibility and safety of ETV before posterior fossa
tumor surgery in adult patients. If patients had symptomatic hydrocephalus before
tumor surgery, an ETV can be performed, followed by early elective tumor surgery.
A prophylactic ETV in asymptomatic patients is not advised. Early elective tumor surgery
should be performed in these patients.
Keywords
endoscopic third ventriculostomy - posterior fossa tumor - management of hydrocephalus
