Infratentorial complications following preresection CSF diversion in children with posterior fossa tumors.
OBJECTIVE
This report presents the incidence, causes, and morbidity and mortality of infratentorial complications following CSF diversion before resection in children with posterior fossa tumors.


METHODS
The medical records of 437 children admitted to Abo El-Reesh Pediatric University Hospital with a diagnosis of posterior fossa tumor between 2005 and 2012 were retrospectively reviewed. Seven children developed neurological deterioration following CSF diversion due to infratentorial complications. Computed tomography scans revealed intratumoral hemorrhage (ITH) in 5 cases, while upward transtentorial herniation (UTH), as evidenced by obliteration of the quadrigeminal and ambient cisterns, was diagnosed in 2 cases.


RESULTS
Hydrocephalus was noted in 381 patients, and 301 patients underwent CSF diversion before resection. A ventriculoperitoneal (VP) shunt was used in 214 patients, and 6 children (2.8% of shunted cases) deteriorated neurologically (4 due to ITH and 2 due to UTH). Endoscopic third ventriculostomy (ETV) was performed in 87 patients, 1 of whom developed ITH (1.1% of the patients undergoing ETV). Six patients deteriorated within 8 hours (85.7%), whereas 1 patient, the only survivor, deteriorated after 24 hours. The incidence of infratentorial complications between VP shunts and ETVs was not found to be significantly different (p = 0.659). There was a higher risk of such complications in large posterior fossa tumors (diameter ≥ 4 cm) extending close to the tentorial incisura, especially in patients with severe hydrocephalus and significant peritumoral edema.


CONCLUSIONS
Infratentorial complications (ITH and UTH) in children with posterior fossa tumors are not uncommon (2.3%) after preresection CSF diversion (VP shunt or ETV) and are associated with a very poor prognosis in most cases, even with surgical intervention.
Department of Neurosurgery, Kasr Al-Aini Medical School, Cairo University, Cairo, Egypt.
Mohamed Ali
MA
El-Gaidi
Ashraf Hesham Abou
AH
El-Nasr
Ehab Mohamed
EM
Eissa
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004487:Edema / Q000209:etiology; D004806:Ependymoma / Q000150:complications; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D015994:Incidence; D015192:Infratentorial Neoplasms / Q000150:complications* / Q000601:surgery; D008297:Male; D044583:Neuroendoscopy; D012189:Retrospective Studies; D013346:Subarachnoid Space / Q000473:pathology; D020542:Third Ventricle / Q000601:surgery; D014057:Tomography, X-Ray Computed; D017287:Ventriculoperitoneal Shunt / Q000009:adverse effects*; D014696:Ventriculostomy / Q000009:adverse effects* / Q000379:methods
CSF diversion; ETV = endoscopic third ventriculostomy; EVD = external ventricular drainage; ICP = intracranial pressure; ITH = intratumoral hemorrhage; UTH = upward transtentorial herniation; VP = ventriculoperitoneal; hydrocephalus; intratumoral hemorrhage; posterior fossa tumor; upward transtentorial herniation