Prädiktoren für die Notwendigkeit einer Liquorableitung bei Läsionen der hinteren Schädelgrube

The aim of this study is to assess the indication for cerebrospinal fluid (CSF) diversion prior, during and after resection of posterior fossa lesions (PFL), as well as to identify factors predicting persistent hydrocephalus after tumor resection.

We performed a retrospective analysis of patients who underwent surgery for PFL between 2021 and 2023 in our department. The factors evaluated included severity of hydrocephalus (i.e. transependymal flow), tumor location, volume of the tumor, extent of resection and histology.

Thirty-two (16%) of 204 patients with PFL underwent CSF diversion procedures. This cohort was divided into two groups: group A (18 patients), comprising patients who required CSF diversion procedures before or during surgery, and group B (14 patients) including cases with hydrocephalus that occurred after surgery. In general, tumor volume was greater in group A (mean 39,77 +/- 6,06 ml vs. 16,87 +/- 4,37 ml). Additionally, transependymal flow was found to be predictive for the necessity of placement of an external ventricular drainage prior to surgery (p=0,0361), with incomplete tumor removal linked to shunting in this group. In contrast, surgical complications (including intraventricular hemorrhage) were the major predictor of permanent CSF diversion in group B (p=0,0233). While there was no statistical significance, the rate of permanent CSF diversion by shunting was higher in group B (43% vs 17%).

Our study demonstrates tumor size and the presence of transependymal flow as predictive factors of preoperative EVD placement, whereas partial/subtotal resection and surgical complications are predictors of the necessity for shunting.