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,2026,(07):656-661.[doi:10.3760/cma.j.cn101785-202509026]
后颅窝肿瘤合并梗阻性脑积水手术后行脑脊液的分流相关因素分析
- Title:
- 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
- 摘要:
- 目的 探讨后颅窝肿瘤合并梗阻性脑积水患儿术后行脑脊液分流治疗的相关因素。方法 本研究为病例对照研究。收集湖南省儿童医院神经外科2020年1月至2025年9月实施手术治疗的48例后颅窝肿瘤合并梗阻性脑积水患儿临床资料。根据术后随访期间是否行脑脊液分流治疗,分为分流组和非分流组。收集两组患儿一般资料、术前影像学指标、肿瘤及手术相关指标,具体包括年龄、性别、额角-枕角比、第三脑室径、脑室周围水肿深度、肿瘤体积与位置、第四脑室底有无侵犯、脑干受压情况、蛛网膜下腔或脑室播散、术前外引流、肿瘤是否全切除及病理类型等。采用单因素分析比较两组上述指标的差异,并对具有统计学意义的变量进行多因素分析。结果 48例中,9例(18.8%)术后接受脑脊液分流治疗。分流组第四脑室底侵犯人数比例高于非分流组(88.9%比23.1%),差异具有统计学意义(P＜0.001);肿瘤全切率低于非分流组(22.2%比71.8%),差异具有统计学意义(P=0.009);其额角-枕角比(fronto-occipital horn ratio,FOHR)、第三脑室径及肿瘤体积亦较非分流组增高,但差异无统计学意义(P>0.05)。探索性多因素分析显示,第四脑室底侵犯可能增加术后脑脊液分流治疗的风险(OR=21.22,95%CI:2.14~210.22,P=0.009),而肿瘤全切除(gross total resection,GTR)可能降低术后脑脊液分流治疗风险(OR=0.12,95%CI:0.02~0.87,P=0.036)。结论 合并梗阻性脑积水的后颅窝肿瘤患儿术后需行脑脊液分流治疗,可能与第四脑室底侵犯及肿瘤未完全切除有关。第四脑室底侵犯患儿术后需脑脊液分流治疗可能性较大,而达到肿瘤全切除者术后需脑脊液分流治疗可能性较低。术前应重点评估肿瘤与第四脑室底及脑脊液循环通路的关系,以辅助患儿术后持续性脑积水的风险判断及围手术期管理。
- 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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备注/Memo
收稿日期:2025-9-11。
通讯作者:吴水华,Email:292454021@qq.com