An analysis of factors determining the requirement of ventriculoperitoneal shunt surgery in the children suffering from posterior fossa tumour: a single centre retrospective review

Mrinal Bhuyan, Debadatta Saha, Basanta Kumar Baishya


Background: Hydrocephalus is a relatively common occurrence in a children suffering from the posterior fossa tumour (PFTm). However, there is a divided opinion regarding the ventriculoperitoneal shunt (VPS) surgery before the posterior fossa tumour resection in a child. For the better clinical outcome, we should be able to predict which patient will require VPS following the resection of PFTm. Purpose of our retrospective analysis is to analyse various factors that predicts the necessity of VPS following PFTm resection.

Methods: A consecutive series of twenty-six patients who underwent PFTm resection without undergoing VPS preoperatively are analysed in our series.

Results: In our series, we found that the younger age at presentation, incomplete tumour resection, longer period of artificial ventilatory support, insertion of external ventricular drain (EVD) and its duration during the postoperative period correlate the necessity of VPS following PFTm resection. However, the severity of hydrocephalus prior to tumor surgery, tumour size, anatomical location of the tumour, tumour dissemination, use of Dural grafts during closure and histopathological type do not predict the requirement of the VPS following PFTm.

Conclusions: Patients who are younger at diagnosis should be treated with utmost importance. Gross total resection should be the goal. Factors which predict the likelihood of the EVD which parallels the likelihood of postresection hydrocephalus must be prevented for the better clinical outcome.


External ventricular drain, Hydrocephalus, Posterior fossa tumour, Ventriculoperitoneal shunt

Full Text:



Sainte­Rose C, Cinalli G, Roux FE, Maixner R, Chumas PD, Mansour M, et al. Management of hydrocephalus in pediatric patients with posterior fossa tumors: The role of endoscopic third ventriculostomy. J Neurosurg. 2001;95:791-7.

Farwell JR, Dohrmann GJ, Flannery JT. Central nervous system tumors in children CNS tumors in children. Cancer. 1977;40(6):3123-32.

Dias MS, Albright L. Management of hydrocephalus complicating childhood posterior fossa tumors. Pediatr Neurosurg. 1989;15(6):283-90.

Rappaport ZH, Shalit MN. Perioperative external ventricular drainage in obstructive hydrocephalus secondary to infratentorial brain tumours. Acta Neurochirur. 1989;96(3-4):118-21.

Park TS, Hoffman HJ, Hendrick EB, Humphreys RP, Becker LE. Medulloblastoma: clinical presentation and management: experience at the hospital for sick children, Toronto, 1950–1980. J Neurosurg. 1983;58(4):543-52.

Culley DJ, Berger MS, Shaw D, Geyer R. An analysis of factors determining the need for ventriculoperitoneal shunts after posterior fossa tumor surgery in children. Neurosurg. 1994;34:402-7.

Due­Tønnessen BJ, Helseth E. Management of hydrocephalus in children with posterior fossa tumors: Role of tumor surgery. Pediatr Neurosurg. 2007;43:92-6.

Kumar V, Phipps K, Harkness W, Hayward RD. Ventriculo­peritoneal shunt requirement in children with posterior fossa tumours: An 11­year audit. Br J Neurosurg. 1996;10:467-70.

Schijman E, Peter JC, Rekate HL, Sgouros S, Wong TT. Management of hydrocephalus in posterior fossa tumors: How, what, when? Childs Nerv Syst. 2004;20:192-4.

Albright L, Reigel DH. Management of hydrocephalus secondary to posterior fossa tumors. J Neurosurg. 1977;46(1):52-5.

Raimondi AJ, Tomita T. Hydrocephalus and infratentorial tumors: incidence, clinical picture, and treatment. J Neurosurg. 1981;55(2):174-82.

Di Rocco F, Jucá CE, Zerah M, Sainte­Rose C. Endoscopic third ventriculostomy and posterior fossa tumors. World Neurosurg. 2013;79:S18.e15-9.

Stein BM, Tenner MS, Fraser RA. Hydrocephalus following removal of cerebellar astrocytomas in children. J Neurosurg. 1972;36(6):763-8.

Lam S, Reddy GD, Lin Y, Jea A. Management of hydrocephalus in children with posterior fossa tumors. Surg Neurol Int. 2015;6(Suppl 11):346-8.

Allen JC, Epstein F. Medulloblastoma and other primary malignant neuroectodermal tumors of the CNS: The effect of patients' age and extent of disease on prognosis. J Neurosurg. 1982;57(4):446-51.

Lee M, Wisoff JH, Abbott R, Freed D, Epstein FJ. Management of hydrocephalus in children with medulloblastoma: prognostic factors for shunting. Pediatr Neurosurg. 1994;20(4):240-7.

Papo I, Caruselli G, Luongo A. External ventricular drainage in the management of posterior fossa tumors in children and adolescents. Neurosurg. 1982;10(1):13-5.

Schmid UD, Seiler RW. Management of obstructive hydrocephalus secondary to posterior fossa tumors by steroids and subcutaneous ventricular catheter reservoir. J Neurosurg. 1986;65(5):649-53.