Management of hydrocephalus in posterior fossa tumors: how, what, when?

OBJECT: The aim of this work is to analyze the current management of hydrocephalus associated with posterior fossa (PF) tumors.

METHODS: The personal perspectives of experienced pediatric neurosurgeons were presented at a virtual round table.

DISCUSSION: Preoperative hydrocephalus has been reported in about 80% of patients with PF tumors and postoperative treatment is required for persistent or progressive hydrocephalus in about 25-30% of the cases. Preoperative management includes external ventricular drainage (EVD), endoscopic third ventriculostomy (ETV), shunt insertion, and no treatment at all, while ETV and ventriculo-peritoneal (V-P) shunt are recommended as treatment after PF craniotomy.

CONCLUSION: There is no consensus on the way hydrocephalus should be managed before, during, and after PF surgery. While awaiting prospective multicenter trials of various management schemes the perioperative management of hydrocephalus in the context of posterior fossa tumors should be considered as options.