Management postoperativer Hygrome nach intraaxialer Tumorresektion mit Ventrikeleröffnung

When performing extensive, intraaxial tumor resections, opening of the ventricle and thereby creating a connection between the resection cavity and the ventricles sometimes might not be preventable. Some patients develop postoperative hygromas. Optimal management of these hygromas, i.e., necessity and timing of a surgical intervention, have not been determined yet.

In this single-center, retrospective study, patients having undergone craniotomy and intraaxial tumor resection between 2018 and 2023 were included. Operative reports and imaging data were screened for intraoperative opening of the lateral or third ventricle. Patients in which an opening was confirmed were then evaluated for development of postoperative hygroma (I), subsequent therapy strategies (II) as well as clinical and imaging outcome (III).

Overall, 608 patients having undergone intraaxial tumor resection were screened. Ventricular opening was reported in 224 patients (37%) and 89 patients (15%) subsequently developed a postoperative hygroma. Of these patients, 27 underwent surgical intervention for hygroma evacuation, i.e., burr hole trepanation (n=7), ventriculo-/subduroperitoneal shunt implantation (n=13) or open revision (n=7). A complete or near complete remission was observed in 17 patients (63%) having undergone surgical intervention. Within the non-intervention cohort (n=62), 38 patients (61%) showed complete or near complete remission (p=0.99). When looking at patients with hygromas measuring >1 cm, a remission was seen in 11/18 patients (61%) having undergone hygroma evacuation and in 5/13 patients (39%) in the non-intervention cohort (p=0.29).

Postoperative hygroma is a common phenomenon after surgical opening of the lateral or third ventricle. These hygromas show a high rate of spontaneous partial or complete remission, while surgical intervention might be warranted in symptomatic hygromas measuring > 1cm.