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Posterior fossa lesion resection and post-operative hydrocephalus: a multicenter retrospective study for risk factor identification and state-of-art treatment methods
EANS Academy. Moiraghi A. 09/26/19; 276033; EP04036
Dr. Alessandro Moiraghi
Dr. Alessandro Moiraghi

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Abstract
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Background: Ventricular dilation due to cerebro-spinal fluid pathways obstruction is one of the most frequent complications of patients harbouring a posterior fossa lesion. Methods and timing to treat pre-operative ventricular dilation or post-operative hydrocephalus (HCP) are not homogeneous among different centers.
Methods: We retrospectively analyzed data of patients undergoing surgery for posterior fossa lesions from January 2007 to June 2018 at two neurosurgical centers. Demographics, lesion size and location (A=Extra-Axial Cerebello-Pontine Angle, B=Intrinsic Cerebellar Lesion, C=Extra-Axial Cranio-Cervical Junction, D=Intra-Axial Brainstem, E=Pineal Region), pre-operative and post-operative shunt procedures (permanent or temporary ventricular and spinal shunts, ventriculostomy and reservoir), presence and grade of pre-operative and post-operative HCP, and patient outcome were reviewed.
Results: One-thousand patients were selected for analysis. Patient groups were separately analyzed, based on the presence or absence of pre-operative ventricular dilation. 215 patients (21,5%) presented post-operative HCP. Tumor size showed a linear correlation with post-operative HCP occurrence (7,2% for lesions>3.5 cm; p< 0,0001). As for the location, Group B had a significant augmented risk to present post-operative HCP (6,2%) or to maintain pre-operative HCP after surgery (22,8%), compared respectively to Group A (4,1% and 12,8%; p< 0,001) and Group C (3,7% and 7,4%; p< 0,005). Post-operative complications directly related to surgery were significantly related to ex-novo post-operative HCP and pre-operative HCP persistence (52,9% and 39%; p< 0.0001). Out of the 296 patients with pre-operative ventricular dilation, 132 patients presented regression of pre-operative HCP and only 21,2% of them had a pre-operative shunt procedure.
Conclusions: If not symptomatic, pre-operative ventricular dilation resolved after surgery without additional pre-operative shunt procedures in half the patients undergoing posterior fossa surgery. Intrinsic cerebellar lesions and tumor size seem to be independent risk factors for post-operative HCP occurrence and persistency of pre-operative HCP. In this cohort post-operative HCP occurrence is strongly related to post-operative complications.
Background: Ventricular dilation due to cerebro-spinal fluid pathways obstruction is one of the most frequent complications of patients harbouring a posterior fossa lesion. Methods and timing to treat pre-operative ventricular dilation or post-operative hydrocephalus (HCP) are not homogeneous among different centers.
Methods: We retrospectively analyzed data of patients undergoing surgery for posterior fossa lesions from January 2007 to June 2018 at two neurosurgical centers. Demographics, lesion size and location (A=Extra-Axial Cerebello-Pontine Angle, B=Intrinsic Cerebellar Lesion, C=Extra-Axial Cranio-Cervical Junction, D=Intra-Axial Brainstem, E=Pineal Region), pre-operative and post-operative shunt procedures (permanent or temporary ventricular and spinal shunts, ventriculostomy and reservoir), presence and grade of pre-operative and post-operative HCP, and patient outcome were reviewed.
Results: One-thousand patients were selected for analysis. Patient groups were separately analyzed, based on the presence or absence of pre-operative ventricular dilation. 215 patients (21,5%) presented post-operative HCP. Tumor size showed a linear correlation with post-operative HCP occurrence (7,2% for lesions>3.5 cm; p< 0,0001). As for the location, Group B had a significant augmented risk to present post-operative HCP (6,2%) or to maintain pre-operative HCP after surgery (22,8%), compared respectively to Group A (4,1% and 12,8%; p< 0,001) and Group C (3,7% and 7,4%; p< 0,005). Post-operative complications directly related to surgery were significantly related to ex-novo post-operative HCP and pre-operative HCP persistence (52,9% and 39%; p< 0.0001). Out of the 296 patients with pre-operative ventricular dilation, 132 patients presented regression of pre-operative HCP and only 21,2% of them had a pre-operative shunt procedure.
Conclusions: If not symptomatic, pre-operative ventricular dilation resolved after surgery without additional pre-operative shunt procedures in half the patients undergoing posterior fossa surgery. Intrinsic cerebellar lesions and tumor size seem to be independent risk factors for post-operative HCP occurrence and persistency of pre-operative HCP. In this cohort post-operative HCP occurrence is strongly related to post-operative complications.
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