Endoscopic third ventriculostomy: the best option in the treatment of persistent hydrocephalus after posterior cranial fossa tumour removal?
BACKGROUND
Ten to 40% of children operated on for a posterior fossa tumour require a further surgical procedure for the management of a persisting active ventricular dilation. The management of this kind of hydrocephalus is still controversial.


OBJECTIVE
To prospectively evaluate the effectiveness of post-operative endoscopic third ventriculostomy (ETV) in the management of persistent active hydrocephalus in a series of children operated on for a posterior cranial fossa tumour.


METHODS
The management protocol consisted of: (1) placement of a peri-operative antibiotic impregnated external ventricular catheter (Bactiseal) and tumour removal, (2) post-operative intracranial pressure (ICP) monitoring through the external ventricular drainage, (3) ETV in case of persistent ventricular dilation and persistently abnormal high ICP values and (4) ventriculoperitoneal shunt implantation in case of ETV failure.


RESULTS
Thirty on a total of 104 children (28.8%) operated on between January 2001 and February 2007 at our institution needed a further surgical treatment for the persistence of the hydrocephalus after the removal of their posterior cranial fossa tumour. They were sub-divided in two groups according to the early (group 1--21 patients) or later (group 2--nine patients) definition of the persistence of an active ventricular dilation based on clinical, radiological and ICP monitoring data. ETV was successful in 90.0% of the patients in the present series (27/30 patients), without statistically significant differences among the two groups considered.


CONCLUSIONS
Post-operative ETV should be considered the best option to treat persistent hydrocephalus after the removal of posterior fossa tumours.
Tamburrini
G
G
Paediatric Neurosurgery, Institute of Neurosurgery, Catholic University Medical School, Rome, Italy. gianpiero.tamburrini@rm.unicatt.it
Pettorini
B L
BL
Massimi
L
L
Caldarelli
M
M
Di Rocco
C
C
D000293:Adolescent; D001932:Brain Neoplasms / Q000150:complications / Q000473:pathology / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D007223:Infant; D015192:Infratentorial Neoplasms / Q000150:complications / Q000473:pathology / Q000601:surgery*; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D017063:Outcome Assessment, Health Care / Q000379:methods; D011183:Postoperative Complications / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D011446:Prospective Studies; D020542:Third Ventricle / Q000473:pathology / Q000601:surgery*; D014057:Tomography, X-Ray Computed / Q000379:methods; D014696:Ventriculostomy / Q000379:methods*