Hydrocephalus is often associated with paediatric posterior fossa tumours. About 75% of patients at the time of presentation have hydrocephalus. Following resection of posterior fossa tumours, 1/3 of the patients have persistent hydrocephalus.
The risk factors of persistent hydrocephalus in patient with posterior fossa tumours include:
- medulloblastomas, ependymomas, brainstem gliomas
- tumours of the IVth ventricles with obstruction of the ventricular outlets
- papilloedema at presentation
- moderate/severe hydrocephalus
- transependymal oedema
- Age < 2 years
Management
The options for pre-op management of hydrocephalus are:
- Conservative management with dexamethasone and close observation
- endoscopic third ventriculostomy
- external ventricular drain
If a patients presents with hydrocephalus with GCS deterioration, the patient would require CSF diversion. There is currently controversy on whether such patient should undergo EVD or ETV.
Ganealingam Narenthiran on December 7, 2021