title: Shall we treat hydrocephalus associated to brain stem glioma in children?
abstract: OBJECTIVE
  Brain stem glioma accounts for 6-9% of brain tumors in children. Tumor progression may lead to CSF pathway obstruction and development of hydrocephalus. We retrospectively reviewed charts of patients consecutively treated in our institution with diffuse intrinsic pontine glioma in order to assess incidence of hydrocephalus, its management, and its impact on overall survival. All patients had brain stem glioma not amenable to surgery. Cases with exophytic brain stem glioma were excluded.
  
  
  RESULTS
  Fifty-one children were treated from January 2005 to December 2010 for brain stem glioma in the Pediatric Neurosurgery Department of Necker Enfants Malades, Paris, France. Hydrocephalus occurred in 11 of them (22%). They were six boys and five girls; the average and median time from tumor diagnosis to onset of hydrocephalus were 5.3 and 3.2 months, respectively, while average and median time from onset of hydrocephalus to death were 5.3 and 2.8 months, respectively. Hydrocephalus was treated in nine patients by a ventriculoperitoneal (VP) shunt and in two patients by an endoscopic third ventriculostomy. Because of early failure, a VP shunt was implanted in one child.
  
  
  CONCLUSIONS
  The overall 1-year survival rate was 33%. Survival rate of patients with such obstructive hydrocephalus was not significantly different from patients harboring brain stem glioma who did not develop hydrocephalus. Furthermore, hydrocephalus was not related to terminal tumor progression. Considering both risks and benefit of treatment, VP shunt could be proposed, on the base of our experience, as the first option in spite of the apparently obstructive nature of the hydrocephalus associated to a brain stem tumor.
authors.affiliation: Department of Paediatric Neurosurgery, Hôpital Necker Enfants Malades, APHP, 149, rue de sèvres, 75015 Paris, France. thomas.roujeau@nck.aphp.fr
authors.forename: Thomas
authors.initials: T
authors.lastname: Roujeau
authors.forename: Federico
authors.initials: F
authors.lastname: Di Rocco
authors.forename: Christelle
authors.initials: C
authors.lastname: Dufour
authors.forename: Franck
authors.initials: F
authors.lastname: Bourdeaut
authors.forename: Stephanie
authors.initials: S
authors.lastname: Puget
authors.forename: Christian Sainte
authors.initials: CS
authors.lastname: Rose
authors.forename: Michel
authors.initials: M
authors.lastname: Zerah
mesh_terms: D000293:Adolescent; D020295:Brain Stem Neoplasms / Q000150:complications* / Q000401:mortality; D002648:Child; D002675:Child, Preschool; D005260:Female; D005910:Glioma / Q000150:complications* / Q000401:mortality; D006801:Humans; D006849:Hydrocephalus / Q000209:etiology* / Q000401:mortality / Q000601:surgery*; D008297:Male; D010372:Pediatrics; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome; D014696:Ventriculostomy / Q000379:methods*