Evaluation of clinical characteristics as indicators for shunt procedure in patients with medulloblastoma

Paunović, A.; Milisavljević, F.; Bošković, J.

doi:10.1016/j.pbj.2017.07.151

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Aim: Determing clinical characteristics and parameters reliable as predictors of the need for the shunt installation and their relation to the treatment outcome.

Introduction: Medulloblastoma represents the most common pediatric tumor, that most frequently involves posterior cranial fossa and often manifests as hydrocephalus. Current therapy involves tumor excision and posterior cranial fossa decompression, with or without temporary external drainage of cerebrospinal fluid, endoscopic ventriculocisternostomy and ventriculoperitoneal (VP) shunt placement.

Methods: This retrospective study included 36 patients treated in the period from January 1st 2007 to December 31st 2015 in the Clinic of Neurosurgery, Clinical Center of Serbia. Basic demographic data, symptoms and signs at admission, degree of tumor resection and disease outcome information were analyzed.

Results: 22 patients (61.1%) were male and 14 (38.9%) were female, most of them 4–14 years old (58.3). Sex and age showed no significant corelation with VP shunt installation, or timing of shunt installation. VP shunt was installed in 92% of patients, in 33.3% prior to and in remaining after surgery. The most frequently observed symptoms on admission were cerebellar symptomatology (91.2%), headache (75.7%) and vomiting (68.5%), which showed no significant correlation with the VP shunt installation and shunt installation timing. In 83% of patients total resection was achieved. The degree of tumor resectability and VP shunt installation were significantly related (p<0.001). Correlation among shunt installation and treatment outcomes, as well as the shunt installation timing and outcome showed a statistical significance (p<0.001).

Conclusion: No clinical characteristics reliable as prognostic parameter for VP shunt installation in medulloblastoma patients have been found. Shunt placement is recommended in all cases of incomplete tumor resection, unless already placed preoperatively. Patients with a shunt placed prior to surgery have had significantly better outcome.1–35

References

[1]

P.K. Lachi, F.A.J.D. Syed, I. Moinca, et al.

Medulloblastoma: a common pediatric tumor: prognostic factors and predictors of outcome.

Asian J Neurosurg, 10 (2015), pp. 50

http://dx.doi.org/10.4103/1793-5482.151516 | Medline

[2]

K.K. Koeller, E.J. Rushing.

From the archives of the AFIP: medulloblastoma: a comprehensive review with radiologic-pathologic correlation.

Radiographics, 23 (2003), pp. 1613-1637

http://dx.doi.org/10.1148/rg.236035168 | Medline

[3]

M.D. Taylor, P.A. Northcott, A. Korshunov, et al.

Molecular subgroups of medulloblastoma: the current consensus.

Acta Neuropathol, 123 (2012), pp. 465-472

http://dx.doi.org/10.1007/s00401-011-0922-z | Medline

[4]

N.L. David, P. Arie, R. Guido, et al.

The 2016 World Health Organization Classification of Tumors of the Central Nervous System: a summary.

Acta Neuropathol, 131 (2016), pp. 803-820

http://dx.doi.org/10.1007/s00401-016-1545-1 | Medline

[5]

A.L. Albright, I.F. Pollack, P.D. Adelson.

Principles and practice of pediatric neurosurgery.

3rd ed., Thieme, (2014),

[6]

E.M. Thompson, T. Hielscher, E. Bouffet, et al.

Prognostic value of medulloblastoma extent of resection after accounting for molecular subgroup: a retrospective integrated clinical and molecular analysis.

Lancet Oncol, 17 (2016), pp. 484-495

http://dx.doi.org/10.1016/S1470-2045(15)00581-1 | Medline

[7]

M.R. Nikitovic, I.V. Golubicic, N.D. Borojevic, et al.

Pediatric brain tumors-diagnostic and treatment.

Acta Chir Iugosl, 56 (2009), pp. 19-24

Medline

[8]

M.R. Nikitovic, I.V. Golubicic.

Treatment options for childhood medulloblastoma.

Vojnosanit Pregl, 70 (2013), pp. 773-777

Medline

[9]

M. Fatema, J.D. Ira.

Treatment approach for recurrent medulloblastoma.

Clin Insights: Opt Therapy Pediatr Medulloblastoma, (2015), pp. 59-73

[10]

G. Pilkington, D. Walker.

Guidelines on the diagnosis and management of Adult PNETs.

Br Neuro-Oncol Soc/NCAT Rare Tumour Guidelines, (2011),

[11]

M.H. Handler, B. Callahan.

Laparoscopic placement of distal ventriculoperitoneal shunt catheters.

J Neurosurg Pediatr, 2 (2008), pp. 282-285

http://dx.doi.org/10.3171/PED.2008.2.10.282 | Medline

[12]

R.P. Naftel, J.L. Argo, C.N. Shannon, et al.

Laparoscopic versus open insertion of the peritoneal catheter in ventriculoperitoneal shunt placement: review of 810 consecutive cases.

J Neurosurg, 115 (2011), pp. 151-158

http://dx.doi.org/10.3171/2011.1.JNS101492 | Medline

[13]

J. Roth, B. Sagie, A. Szold, H. Elran.

Laparoscopic versus non-laparoscopic-assisted ventriculoperitoneal shunt placement in adults. A retrospective analysis.

Surg Neurol, 68 (2007), pp. 177-184

http://dx.doi.org/10.1016/j.surneu.2006.10.069 | Medline

[14]

D. Pettersson, K.R. Schmitz, M. Jeffrey, et al.

Medulloblastoma: seeding of VP shunt tract and peritoneum.

Clin Pract, 2 (2012), pp. e37

http://dx.doi.org/10.4081/cp.2012.e37 | Medline

[15]

B. Jennett, M. Bond.

Assessment of outcome after severe brain damage.

Lancet, 7905 (1975), pp. 480-484

[16]

D.J. Culley, M.S. Berger, D. Shaw, et al.

An analysis of factors determining the need for ventriculoperitoneal shunts after posterior fossa tumor surgery in children.

Neurosurgery, 34 (1994), pp. 402-407

Medline

[discussion 407–8]

[17]

J. Riva-Cambrin, A.S. Detsky, M. Lamberti-Pasculli, et al.

Predicting postresection hydrocephalus in pediatric patients with posterior fossa tumors.

J Neurosurg Pediatr, 3 (2009), pp. 378-385

http://dx.doi.org/10.3171/2009.1.PEDS08298 | Medline

[18]

L. Albright, D.H. Reigel.

Management of hydrocephalus secondary to posterior fossa tumors.

J Neurosurg, 46 (1977), pp. 52-55

http://dx.doi.org/10.3171/jns.1977.46.1.0052 | Medline

[19]

A.J. Raimondi, T. Tomita.

Hydrocephalus and infratentorial tumors. Incidecence, clinical picture and treatment.

J Neurosurg, 55 (1981), pp. 174-182

http://dx.doi.org/10.3171/jns.1981.55.2.0174 | Medline

[20]

J. Hekmatpanah, S. Mullan.

Ventriculo-caval shunt in the menagement of posterios fossa tumors.

J Neurosurg, 26 (1967), pp. 609-613

http://dx.doi.org/10.3171/jns.1967.26.6.0609 | Medline

[21]

C. Schneider, V. Ramaswamy, A.V. Kulkarni, et al.

Clinical implication of medulloblastoma subgroups: incidence of CSF diversion surgery.

J Neurosurg Pediatr, (2014), pp. 1-7

http://dx.doi.org/10.3171/2017.5.PEDS16674 | Medline

[22]

P. Foreman, S. McClugage, R. Naftel, et al.

Validation and modification of a predictive model of postresection hydrocephalus in pediatric patients with posterior fossa tumors.

J Neurosurg Pediatr, 12 (2013), pp. 220-226

http://dx.doi.org/10.3171/2013.5.PEDS1371 | Medline

[23]

D. Morelli, B. Pirotte, A. Lubansu, et al.

Persistent hydrocephalus after early surgical management of posterios fossa tumors in children:is routine preoperative endoscopic third ventriculostomy justified?.

J Neurosurg, 103 (2005), pp. 247-252

http://dx.doi.org/10.3171/ped.2005.103.3.0247 | Medline

[24]

K.K. Gnanalingham, J. Lafuente, D. Thompson, et al.

The natural history of ventriculomegaly and tonsilar herniation in children with posterios fossa tumours-an MRI study.

Pediatr Neurosurg, 39 (2003), pp. 246-253

http://dx.doi.org/72869 | Medline

[25]

C. Sainte-Rose, G. Cinalli, F.E. Roux, et al.

Management of hydrocephalus in pediatric patients with posterios fossa tumors: the role of endoscopic thirs ventriculostomy.

J Neurosurg, 95 (2001), pp. 791-797

http://dx.doi.org/10.3171/jns.2001.95.5.0791 | Medline

[26]

G. Tamburrini, B.L. Pettorini, L. Massimi, et al.

Endoscopic third ventriculostomy: the best option in the treatment of persistent hydrocephalus after posterior cranial fossa tumour removal?.

Childs Nerv Syst, 24 (2008), pp. 1405-1412

http://dx.doi.org/10.1007/s00381-008-0699-0 | Medline

[27]

S. Tuli, J. Tuli, J. Drake, et al.

Predictors of death in pediatric patients requiring cerebrospinal fluid shunts.

J Neurosurg, 100 (2004), pp. 442-446

http://dx.doi.org/10.3171/ped.2004.100.5.0442 | Medline

[28]

J.M. Drake, J.R.W. Kestle, R. Milner, et al.

Randomized trial of cerebrospinal fluid shunt valve design in pediatric hydrocephalus.

Neurosurgery, 43 (1998), pp. 294

Medline

[29]

D.D. Cochrane, J.R.W. Kestle.

The influence of surgical operative experience on the duration of first ventriculoperitoneal shunt function and infection.

Pediatr Neurosurg, 38 (2003), pp. 295-301

http://dx.doi.org/70413 | Medline

[30]

R.L. McLaurin.

Disadvantages of the preoperative shunt in posterios fossa tumors.

Clin Neurosurg, 30 (1983), pp. 286-292

Medline

[31]

W.A. Taylor, N.V. Todd, S.E. Leighton.

CSF drainage in patients with posterios fossa tumours.

Acta Neurochir(Wien), 117 (1992), pp. 1-6

[32]

F. Di Rocco, C.E. Juca, M. Zerah, et al.

Endoscopic third ventriculostomy and posterior fossa tumors.

WNEU, 79 (2013), pp. S18.e15-S18.e19

[33]

T. Bouras, S. Sgouros.

Complications of endoscopic third ventriculostomy.

J Neurosurg Pediatr, 7 (2011), pp. 643-649

http://dx.doi.org/10.3171/2011.4.PEDS10503 | Medline

[34]

A.V. Kulkarni, J.M. Drake, Mallucci Cl, et al.

Endoscopic third ventriculostomy in the treatment of childhood hydrocephalus.

J Pediatr, 155 (2009), pp. 254-259

http://dx.doi.org/10.1016/j.jpeds.2009.02.048 | Medline

[35]

J.M. Drake.

Canadian Pediatric Neurosurgery Study Group. Endoscopic third ventriculostomy in pediatric patients: the Canadian experience.

Neurosurgery, 60 (2007), pp. 881-886

http://dx.doi.org/10.1227/01.NEU.0000255420.78431.E7 | Medline

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