Hydrocephalus in Pediatric Patients with Posterior Fossa Tumors

Abstract

Hydrocephalus associated with posterior fossa tumors in children is a typical problem and can be lethal. It is usually of the obstructive type and its management has always been problematic both preoperatively and postoperatively. While the majority of patients will not require permanent treatment like endoscopic third ventriculostomy (ETV) or shunting procedures for hydrocephalus postoperatively, those patients who do so appear to suffer a stormier postoperative course and are subject to the problems associated with these procedures and devices. Although in the past it was often appropriate to shunt all these patients preoperatively, technological advances and changes in the availability of neuroimaging have allowed earlier diagnosis of these tumors. Early surgery of the tumor is the mainstream of the treatment. However when early surgery is not possible, even though medical interventions like the use of corticosteroids, mannitol, and diuretics and fluid restriction can decrease the early risks, the mortality and morbidity associated with hydrocephalus can make a surgical intervention like ETV, shunting, or temporary external ventricular drainage (EVD) for hydrocephalus inevitable. Also protocols of high-dose chemotherapy for medulloblastomas preoperatively make the concomitant management of hydrocephalus even more problematic and complex as any of those interventions bring its own risks with an unnecessary intervention.