Transient and permanent hydrocephalus following resection of brain metastases located in the posterior fossa: incidence, risk factors and the necessity of perioperative external ventricular drainage placement.

IF 3.2 2区医学 Q2 CLINICAL NEUROLOGY Journal of Neuro-Oncology Pub Date : 2024-11-28 DOI:10.1007/s11060-024-04890-1

Ehab Shabo, Anna-Laura Potthoff, Thomas Zeyen, Julian P Layer, Stefan Ehrentraut, Jasmin Scorzin, Felix Lehmann, Nils Christian Lehnen, Mohammed Banat, Johannes Weller, Florian Gessler, Daniel Paech, Motaz Hamed, Valeri Borger, Alexander Radbruch, Ulrich Herrlinger, Leonie Weinhold, Hartmut Vatter, Matthias Schneider

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引用次数: 0

Abstract

Purpose: Prophylactic insertion of an external ventricular drainage (EVD) prior to the resection of posterior fossa metastases (PFMs) is a common approach to address postoperative transient and permanent hydrocephalus. However, predicting surgery-related hydrocephalus in the preoperative phase continues to be a challenge. This study aims to analyze the incidence, preoperatively collectable risk factors and necessity of perioperative external ventricular drainage placement after posterior fossa metastasis surgery.

Methods: All patients undergoing surgery for PFMs at the authors' neuro-oncological center between 2015 and 2021 were identified and assessed for postoperative hydrocephalus occurrence. Tumour volume, edema volume, and 4th ventricle volume were assessed on preoperative magnetic resonance imaging scans using the IntelliSpace Portal 5.0. A multivariable logistic regression analysis was performed to identify possible predictors for postoperative hydrocephalus occurrence.

Results: Postoperative hydrocephalus occurred in 14 of the 130 identified PFM patients (11%). Multivariable analysis and receiver operating characteristic (ROC) analysis revealed a 4th -ventricle-to-tumor-volume ratio ≤ 0.02 (OR 33.1, 95% CI 3.8-284.3, p = 0.001), an edema-to- tumor-volume ratio ≤ 0.85 (OR 10.6, 95% CI 2.4-47.4, p = 0.002), an imaging-morphological contact to the 4th ventricle (OR 5, 95% CI 1.4-18, p = 0.013), and multiple intracranial metastases (OR 2.4, 95% CI 1-5.9, p = 0.045) as independent predictors for surgery-related postoperative hydrocephalus occurrence.

Conclusion: The present study identifies preoperatively detectable risk factors for the occurrence of postoperative hydrocephalus following surgery for PFMs. These findings may provide guidance in clinical decision-making regarding prophylactic EVD placement.

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位于后窝的脑转移灶切除术后的短暂性和永久性脑积水：发生率、风险因素和围手术期脑室外引流置管的必要性。

目的：在后窝转移瘤（PFMs）切除术前预防性插入脑室外引流管（EVD）是解决术后短暂性和永久性脑积水的常用方法。然而，在术前阶段预测手术相关脑积水仍然是一项挑战。本研究旨在分析后窝转移手术后脑室外引流的发生率、术前可收集的风险因素以及围手术期脑室外引流置管的必要性：确定2015年至2021年间在作者所在神经肿瘤中心接受PFM手术的所有患者，并评估术后脑积水发生情况。使用 IntelliSpace Portal 5.0 对术前磁共振成像扫描的肿瘤体积、水肿体积和第四脑室体积进行评估。为确定术后脑积水发生的可能预测因素，进行了多变量逻辑回归分析：结果：在 130 例已确定的 PFM 患者中，有 14 例（11%）发生了术后脑积水。多变量分析和接收器操作特征（ROC）分析显示，第四脑室与肿瘤体积比值≤0.02（OR 33.1，95% CI 3.8-284.3，P = 0.001），水肿与肿瘤体积比值≤0.85（OR 10.6，95% CI 2.4-47.4，P = 0.002）、第四脑室影像形态接触（OR 5，95% CI 1.4-18，p = 0.013）和颅内多发转移（OR 2.4，95% CI 1-5.9，p = 0.045）是手术相关术后脑积水发生的独立预测因素：本研究确定了可在术前检测到的 PFMs 手术后发生术后脑积水的风险因素。这些发现可为预防性 EVD 置入的临床决策提供指导。

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来源期刊

Journal of Neuro-Oncology 医学-临床神经学

CiteScore

6.60

自引率

7.70%

发文量

277

审稿时长

3.3 months

期刊介绍： The Journal of Neuro-Oncology is a multi-disciplinary journal encompassing basic, applied, and clinical investigations in all research areas as they relate to cancer and the central nervous system. It provides a single forum for communication among neurologists, neurosurgeons, radiotherapists, medical oncologists, neuropathologists, neurodiagnosticians, and laboratory-based oncologists conducting relevant research. The Journal of Neuro-Oncology does not seek to isolate the field, but rather to focus the efforts of many disciplines in one publication through a format which pulls together these diverse interests. More than any other field of oncology, cancer of the central nervous system requires multi-disciplinary approaches. To alleviate having to scan dozens of journals of cell biology, pathology, laboratory and clinical endeavours, JNO is a periodical in which current, high-quality, relevant research in all aspects of neuro-oncology may be found.