Zhang Jinwei,Wu Shuihua,Yuan Liping.Analysis of factors associated with postoperative cerebrospinal fluid shunting in children with posterior fossa tumors complicated by obstructive hydrocephalus[J].Journal of Clinical Pediatric Surgery,,():656-661.[doi:10.3760/cma.j.cn101785-202509026]
Analysis of factors associated with postoperative cerebrospinal fluid shunting in children with posterior fossa tumors complicated by obstructive hydrocephalus
- Keywords:
- Infratentorial Neoplasms; Obstructive Hydrocephalus; Ventriculoperitoneal Shunt; Fourth Ventricle; Child
- Abstract:
- Objective To investigate factors associated with postoperative cerebrospinal fluid shunting in children with posterior fossa tumors complicated by obstructive hydrocephalus. Methods This was a retrospective case-control study.Clinical data of 48 children with posterior fossa tumors complicated by obstructive hydrocephalus who underwent surgery in the Department of Neurosurgery,Hunan Children’s Hospital from January 2020 to September 2025 were collected.According to whether cerebrospinal fluid shunting was performed during postoperative follow-up,the children were divided into the shunt group and non-shunt group.General data,preoperative imaging parameters,and tumor-and surgery-related variables were collected,including age,sex,fronto-occipital horn ratio,third ventricular diameter,depth of periventricular edema,tumor volume and location,invasion of the fourth ventricular floor,brainstem compression,subarachnoid or ventricular dissemination,preoperative external drainage,gross total resection,and pathological type.Univariate analysis was used to compare these variables between the two groups,and variables with statistical significance were further included in multivariable analysis.Results Among the 48 children,9 cases (18.8%) underwent postoperative cerebrospinal fluid shunting.The proportion of children with invasion of the fourth ventricular floor was higher in the shunt group than in the non-shunt group[88.9%(8/9) vs.23.1%(9/39)],and the difference was statistically significant (P<0.001).The gross total resection rate was lower in the shunt group than in the non-shunt group[22.2%(2/9) vs.71.8%(28/39)],and the difference was statistically significant (P=0.009).The fronto-occipital horn ratio,third ventricular diameter,and tumor volume were also higher in the shunt group than in the non-shunt group,but the differences were not statistically significant (P>0.05).Exploratory multivariable analysis showed that invasion of the fourth ventricular floor might increase the risk of postoperative cerebrospinal fluid shunting (OR=21.22,95%CI:2.14-210.22,P=0.009),whereas gross total resection might reduce the risk of postoperative cerebrospinal fluid shunting (OR=0.12,95%CI:0.02-0.87,P=0.036).Conclusion The need for postoperative cerebrospinal fluid shunting in children with posterior fossa tumors complicated by obstructive hydrocephalus may be associated with invasion of the fourth ventricular floor and incomplete tumor resection.Children with invasion of the fourth ventricular floor may have a higher likelihood of requiring postoperative cerebrospinal fluid shunting,whereas those achieving gross total tumor resection may have a lower likelihood of requiring postoperative cerebrospinal fluid shunting.The relationship between the tumor and the fourth ventricular floor,as well as cerebrospinal fluid circulation pathways,should be carefully evaluated before surgery to assist in risk assessment of postoperative persistent hydrocephalus and perioperative management.
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Memo
收稿日期:2025-9-11。
通讯作者:吴水华,Email:292454021@qq.com