Preoperative Prediction Rule for Hydrocephalus in Children with Posterior Fossa Tumors: A Need to Introduce a New Scoring System

Introduction: It has been estimated in a study that ~70% of patients were inadvertently exposed to pre-resection CSF diversionary procedures and hydrocephalus has seen to resolve after tumor resection in 70 to 90% of pediatric and 96% of adult patients. With all these points, it is prudent to explore, evaluate, introduce new, or modify already present predictive criteria such as the Canadian Preoperative Prediction Rule for Hydrocephalus for the judicious decision of pre-resection permanent CSF diversionary procedures.

Objective: To evaluate predictive factors for post-resection hydrocephalus in pediatric patients with posterior cranial fossa tumors

Methodology: We retrieved data of 70 children who had underwent surgery for posterior fossa tumors between January 2018 and December 2019. The medical records of 70 children who underwent surgery for a tumor in the posterior fossa between January 2017 and January 2019 were retrieved and studied retrospectively. Factors evaluated include age, clinical symptoms, tumor type, extent of surgical tumor resection, treatment with EVD and/or ETV, radiological findings, FOHR, and severity of hydrocephalus.

Results: A total of 70 children: 45 males and 25 females, mean age 4.1 ± 3 years. Thirty patients had an EVD inserted before surgery. On T2-weighted imaging, all patients showed no evidence of flow void through the aqueduct secondary to obstruction of CSF outflow by tumor. Modification of radiological criteria that should include sigmoid and transverse sinus diameter, FOHR and Evans index. Updating and applying a “post-op scoring criteria” that takes into account the extent of resection, duration of surgery and intraoperative bleeding. Adding tumor specifications of midline location, superior extension and intra/extraparenchymal locations.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
15 February 2022