title: Cerebrospinal fluid disturbances after 381 consecutive craniotomies for intracranial tumors in pediatric patients.
abstract: OBJECTIVE
  The aim of this study was to investigate the incidence of CSF disturbances before and after intracranial surgery for pediatric brain tumors in a large, contemporary, single-institution consecutive series.
  
  
  METHODS
  All pediatric patients (those < 18 years old), from a well-defined population of 3.0 million inhabitants, who underwent craniotomies for intracranial tumors at Oslo University Hospital in Rikshospitalet between 2000 and 2010 were included. The patients were identified from the authors' prospectively collected database. A thorough review of all medical charts was performed to validate all the database data.
  
  
  RESULTS
  Included in the study were 381 consecutive craniotomies, performed on 302 patients (50.1% male, 49.9% female). The mean age of the patients in the study was 8.63 years (range 0-17.98 years). The follow-up rate was 100%. Primary craniotomies were performed in 282 cases (74%), while 99 cases (26%) were secondary craniotomies. Tumors were located supratentorially in 249 cases (65.3%), in the posterior fossa in 105 (27.6%), and in the brainstem/diencephalon in 27 (7.1%). The surgical approach was supratentorial in 260 cases (68.2%) and infratentorial in 121 (31.8%). Preoperative hydrocephalus was found in 124 cases (32.5%), and 71 (86.6%) of 82 achieved complete cure with tumor resection only. New-onset postoperative hydrocephalus was observed in 9 (3.5%) of 257 cases. The rate of postoperative CSF leaks was 6.3%.
  
  
  CONCLUSIONS
  Preoperative hydrocephalus was found in 32.5% of pediatric patients with brain tumors treated using craniotomies. Tumor resection alone cured preoperative hydrocephalus in 86.6% of cases and the incidence of new-onset hydrocephalus after craniotomy was only 3.5%.
authors.affiliation: Department of Neurosurgery, Oslo University Hospital, Rikshospitalet;
authors.forename: Sayied Abdol Mohieb
authors.initials: SA
authors.lastname: Hosainey
authors.forename: Benjamin
authors.initials: B
authors.lastname: Lassen
authors.forename: Eirik
authors.initials: E
authors.lastname: Helseth
authors.forename: Torstein R
authors.initials: TR
authors.lastname: Meling
mesh_terms: D000293:Adolescent; D001932:Brain Neoplasms / Q000150:complications / Q000601:surgery*; D065634:Cerebrospinal Fluid Leak / Q000453:epidemiology* / Q000209:etiology / Q000628:therapy*; D002557:Cerebrospinal Fluid Shunts; D002648:Child; D002675:Child, Preschool; D058128:Compression Bandages; D003399:Craniotomy / Q000009:adverse effects* / Q000401:mortality; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000453:epidemiology* / Q000209:etiology / Q000601:surgery*; D007223:Infant; D053208:Kaplan-Meier Estimate; D008297:Male; D008581:Meningitis / Q000453:epidemiology* / Q000209:etiology / Q000628:therapy; D044583:Neuroendoscopy; D009664:Norway / Q000453:epidemiology; D011184:Postoperative Period; D057234:Preoperative Period; D011446:Prospective Studies; D012189:Retrospective Studies; D012307:Risk Factors; D013129:Spinal Puncture; D013537:Sutures; D016896:Treatment Outcome
keywords: CI = confidence interval; DNET = dysembryoplastic neuroepithelial tumor; ETV = endoscopic third ventriculostomy; EVD = external ventricular drain; OR = odds ratio; PNET = primitive neuroectodermal tumor; VP = ventriculo-peritoneal; complications; craniotomy; endoscopic third ventriculostomy; external ventricular drain; hydrocephalus; intracranial tumor; oncology; surgical mortality