Predicting postresection hydrocephalus in pediatric patients with posterior fossa tumors.
OBJECTIVE
Approximately 30% of children with posterior fossa tumors exhibit hydrocephalus after tumor resection. Recent literature has suggested that prophylactic endoscopic third ventriculostomy diminishes the risk of this event. Because the majority of patients will not have postoperative hydrocephalus, a preoperative clinical prediction rule that identifies patients at high or low risk for postresection hydrocephalus would be helpful to optimize the care of these children.


METHODS
The authors evaluated a derivation cohort of 343 consecutive children with posterior fossa tumors who underwent treatment between 1989 and 2003. Multivariate methods were used on these data to generate the Canadian Preoperative Prediction Rule for Hydrocephalus. The rule's estimated risk of postresection hydrocephalus was compared with risk observed in 111 independent patients in the validation cohort.


RESULTS
Variables identified as significant in predicting postresection hydrocephalus were age < 2 years (score of 3), papilledema (score of 1), moderate to severe hydrocephalus (score of 2), cerebral metastases (score of 3), and specific estimated tumor pathologies (score of 1). Patients with scores > or = 5 were deemed as high risk. Predicted probabilities for the high- and low-risk groups were 0.73 and 0.25, respectively, from the derivation cohort, and 0.59 and 0.14 after prevalence adjustment compared with the observed values of 0.42 and 0.17 in the validation cohort.


CONCLUSIONS
A patient's score on the Preoperative Prediction Rule for Hydrocephalus will allow improved patient counseling and surgical planning by identifying patients at high risk of developing postresection hydrocephalus. These patients might selectively be exposed to the risks of preresection CSF diversion to improve outcome.
Riva-Cambrin
Jay
J
Department of Neurosurgery, Primary Children's Medical Center, University of Utah, Salt Lake City, Utah 84113, USA. jay.riva-cambrin@hsc.utah.edu
Detsky
Allan S
AS
Lamberti-Pasculli
Maria
M
Sargent
Michael A
MA
Armstrong
Derek
D
Moineddin
Rahim
R
Cochrane
D Douglas
DD
Drake
James M
JM
D000367:Age Factors; D001932:Brain Neoplasms / Q000601:surgery*; D002170:Canada; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000209:etiology* / Q000503:physiopathology; D015192:Infratentorial Neoplasms / Q000601:surgery*; D008297:Male; D015999:Multivariate Analysis; D019635:Neurosurgical Procedures / Q000009:adverse effects*; D010211:Papilledema / Q000209:etiology; D012307:Risk Factors; D012720:Severity of Illness Index; D016896:Treatment Outcome