CC BY-NC-ND 4.0 · Asian J Neurosurg
DOI: 10.1055/s-0044-1779345
Research Article

Hydrocephalus following Brain Tumor Surgery: Factors Correlating with Occurrence of Postoperative Hydrocephalus and Predictive Scoring Model

Raweenut Beangklang
1   Division of Neurosurgery, Department of Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
2   Department of Surgery, Buriram Hospital, Buriram, Thailand
1   Division of Neurosurgery, Department of Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
Chottiwat Tansirisithikul
1   Division of Neurosurgery, Department of Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
Sarun Nunta-aree
1   Division of Neurosurgery, Department of Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
› Author Affiliations
Funding Disclosure No funding was received for this research.


Hydrocephalus following brain tumor surgery is found, although cause of hydrocephalus is optimally eradicated. This study aimed to investigate factors associated with development of postoperative hydrocephalus that requires shunt procedure and generate predictive scoring model of this condition. Demographic, clinical, radiographic, treatment, laboratory, complication, and postoperative data were collected. Binary logistic regression was used to investigate final model for generating predictive scoring system of postoperative hydrocephalus. A total of 179 patients undergoing brain tumor surgery were included. Forty-five (25.1%) patients had postoperative hydrocephalus that required shunt surgery. In univariate analysis, several factors were found to be associated with postoperative hydrocephalus. Strong predictors of postoperative hydrocephalus revealed in multivariate analysis included tumor recurrence before surgery (odds ratio [OR], 4.38; 95% confidence interval [CI], 1.28–14.98; p = 0.018), preoperative hydrocephalus (OR, 6.52; 95% CI, 2.44–17.46; p < 0.001), glial tumor (OR, 3.76; 95% CI, 1.14–12.43; p = 0.030), metastasis (OR, 5.19; 95% CI, 1.72–15.69; p = 0.004), intraventricular hemorrhage (OR, 7.08; 95% CI, 1.80–27.82; p = 0.005), and residual tumor volume (OR, 1.05; 95% CI, 1.01–1.09; p = 0.007). A cutoff predictive score with the best area under curve and optimum cutoff point was utilized for discriminating patients with high risk from individuals with low risk in occurrence of postoperative hydrocephalus. This study reported predictive factors strongly associated with development of postoperative hydrocephalus. Predictive scoring system is useful for identifying patients with an increased risk of postoperative hydrocephalus. Patients classified in the high-risk group require closed surveillance of the hydrocephalus.

Authors' Contributions

R.B. was involved in development or design of methodology, project administration, software, investigation, data collection, formal analysis, visualization, writing- original draft preparation, and approval of the final manuscript. B.S. contributed to conceptualization, development or design of methodology, supervision, formal analysis, writing—reviewing and editing, corresponding author, and approval of the final manuscript. C.T. was involved in writing—reviewing and editing, and approval of the final manuscript. S.N. helped in conceptualization, supervision, writing—reviewing and editing, and approval of the final manuscript.

Ethical Consideration

This study was approved by the Ethics Committee of the Faculty of Medicine Siriraj Hospital, Mahidol University, Thailand; Certificate of Approval (COA) number SI 753/2017. All the patients' data retained full confidentiality in compliance with the Declaration of Helsinki.

Publication History

Article published online:
26 February 2024

© 2024. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

  • References

  • 1 Lassen B, Helseth E, Rønning P. et al. Surgical mortality at 30 days and complications leading to recraniotomy in 2630 consecutive craniotomies for intracranial tumors. Neurosurgery 2011; 68 (05) 1259-1268 , discussion 1268–1269
  • 2 McGirt MJ, Chaichana KL, Gathinji M. et al. Independent association of extent of resection with survival in patients with malignant brain astrocytoma. J Neurosurg 2009; 110 (01) 156-162
  • 3 Montano N, D'Alessandris QG, Bianchi F. et al. Communicating hydrocephalus following surgery and adjuvant radiochemotherapy for glioblastoma. J Neurosurg 2011; 115 (06) 1126-1130
  • 4 Ding J, Guo Y, Tian H. The influence of decompressive craniectomy on the development of hydrocephalus: a review. Arq Neuropsiquiatr 2014; 72 (09) 715-720
  • 5 Duong DH, O'malley S, Sekhar LN, Wright DG. Postoperative hydrocephalus in cranial base surgery. Skull Base Surg 2000; 10 (04) 197-200
  • 6 Fischer CM, Neidert MC, Péus D. et al. Hydrocephalus after resection and adjuvant radiochemotherapy in patients with glioblastoma. Clin Neurol Neurosurg 2014; 120: 27-31
  • 7 Aljubour R, Alomari A, Musharbash A. Risk factors for ventriculoperitoneal shunting in children with posterior fossa tumor. J Royal Med Serv 2017; 24 (01) 45-49
  • 8 Tahara A, de Santana Jr PA, Calfat Maldaun MV. et al. Petroclival meningiomas: surgical management and common complications. J Clin Neurosci 2009; 16 (05) 655-659
  • 9 Kazan S, Acikbas C, Demirez I, Tuncer R, Saveren M. The factors required for V-P shunting in children with posterior fossa tumors. Turk Neurosurg 1998; 8: 71-75
  • 10 Burkhardt JK, Zinn PO, Graenicher M. et al. Predicting postoperative hydrocephalus in 227 patients with skull base meningioma. Neurosurg Focus 2011; 30 (05) E9
  • 11 Hosainey SAM, Lassen B, Hald JK, Helseth E, Meling TR. Risk factors for new-onset shunt-dependency after craniotomies for intracranial tumors in adult patients. Neurosurg Rev 2018; 41 (02) 465-472
  • 12 Culley DJ, Berger MS, Shaw D, Geyer R. An analysis of factors determining the need for ventriculoperitoneal shunts after posterior fossa tumor surgery in children. Neurosurgery 1994; 34 (03) 402-407 , discussion 407–408
  • 13 Kumar V, Phipps K, Harkness W, Hayward RD. Ventriculo-peritoneal shunt requirement in children with posterior fossa tumours: an 11-year audit. Br J Neurosurg 1996; 10 (05) 467-470
  • 14 Thiessen B, DeAngelis LM. Hydrocephalus in radiation leukoencephalopathy: results of ventriculoperitoneal shunting. Arch Neurol 1998; 55 (05) 705-710
  • 15 Taillibert S, Laigle-Donadey F, Chodkiewicz C, Sanson M, Hoang-Xuan K, Delattre JY. Leptomeningeal metastases from solid malignancy: a review. J Neurooncol 2005; 75 (01) 85-99
  • 16 Lee SH, Kong DS, Seol HJ, Nam DH, Lee JI. Ventriculoperitoneal shunt for hydrocephalus caused by central nervous system metastasis. J Neurooncol 2011; 104 (02) 545-551
  • 17 Fuhrmeister U, Ruether P, Dommasch D, Gaab M. Alterations of CSF hydrodynamics following meningitis and subarachnoid hemorrhage. In: Shulman K, Marmarou A, Miller JD, Becker DP, Hochwald GM, Kasner M, eds. Intracranial Pressure IV. New York: Springer-Verlag; 1980: 241-244