Hydrocephalic fits: forgotten but not gone.
BACKGROUND
Hydrocephalic fit is a fatal complication of posterior fossa tumors that is uncommon in modern neurosurgical practices. As such, most primary physicians and neurosurgeons lack experience with hydrocephalic fits, which makes some patients vulnerable to this fatal condition. We analyzed the patterns of hydrocephalic fits that we have observed directly in our hospital or indirectly after referral to our institution.


METHODS
Eight patients who had a brain tumor and hydrocephalic fit before surgery were managed in our institution between 2001 and 2012. The clinical records and radiological data were reviewed and analyzed.


RESULTS
The patients were divided into two groups: One group included six classical patients who were under age 4, had a posterior fossa tumor, and succumbed rapidly after a hydrocephalic fit. The other group consisted of two teenage patients who had germ cell tumors in the third ventricle and had more favorable outcomes after extraventricular drainage (EVD). Missed brain tumor diagnosis, sedation for imaging studies, poor management of elevated intracranial pressure, referral delay, and neglect during referral and transportation contributed hydrocephalic fit development. Only one patient, a 16-year-old girl with a suprasellar germinoma, survived the hydrocephalic fit. Prompt institution of EVD may have helped her recover from the fit.


CONCLUSIONS
Early diagnosis and active preoperative intracranial pressure control are critical in preventing hydrocephalic fits. It is important that primary physicians, pediatricians, and neurosurgeons have a thorough knowledge of brain tumor symptomatology and hydrocephalic fit risks.
Division of Pediatric Neurosurgery, Seoul National University Children's Hospital, 101 Daehak-ro, 110-744, Seoul, Republic of Korea.
Ji Hoon
JH
Phi
Seung-Ki
SK
Kim
Tae Hee
TH
Kang
Kyu-Chang
KC
Wang
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000209:etiology* / Q000601:surgery*; D007223:Infant; D015192:Infratentorial Neoplasms / Q000150:complications*; D008279:Magnetic Resonance Imaging; D008297:Male; D012509:Sarcoma / Q000150:complications*; D014057:Tomography, X-Ray Computed; D014696:Ventriculostomy / Q000379:methods*