Risk factors analysis of ventriculoperitoneal shunt after supratentorial neoplasms surgery in children

doi:10.3969/j.issn.1672-6731.2023.05.006

Abstract

Abstract: Objective To screen the risk factors for ventriculoperitoneal shunt (VPS) after tumor resection in children with supratentorial neoplasms due to new hydrocephalus or progression of existing hydrocephalus. Methods Total 199 children who underwent supratentorial neoplasms resection at Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, from January 2011 to January 2021 were included. Socio-demographic data, course of disease and imaging data, tumor resection- related indicators and hydrocephalus occurrence and progression were collected. The risk factors for the occurrence or progression of existing hydrocephalus after supratentorial neoplasms resection were analyzed by univariate and multivariate Logistic regression. Results Fifteen of 199 children (7.54%) with supratentorial tumors required VPS after surgery, of which 14 had new hydrocephalus or progression of existing hydrocephalus within 2 weeks after surgery. Logistic regression analysis showed the presence of preoperative coexisting hydrocephalus (OR=14.756, 95%CI:3.451-63.089; P=0.000), tumor adjacent to the midline (OR=5.466, 95%CI:1.409-21.203; P=0.014), and large intraoperative bleeding (OR=1.295, 95%CI:1.016-1.650; P=0.037) were risk factors for the need of VPS in children with supratentorial tumors. Conclusions Development or progression of hydrocephalus after tumor resection in children with supratentorial neoplasms occurs mostly within 2 weeks after surgery. Children with preoperative coexisting hydrocephalus, tumor adjacent to the midline, and large intraoperative bleeding should be alerted to development and acute progression of hydrocephalus after surgery.

Key words: Supratentorial neoplasms, Hydrocephalus, Ventriculoperitoneal shunt, Risk factors, Logistic models, Child

摘要： 目的筛查幕上肿瘤患儿肿瘤切除术后因新发脑积水或原有脑积水进展而行脑室-腹腔分流术的危险因素。方法纳入2011年1月至2021年1月于华中科技大学同济医学院附属同济医院行幕上肿瘤切除术的199例患儿，以社会人口学资料、病程与影像学资料、手术相关指标、脑积水发生和急性进展情况作为评价指标，采用单因素和多因素逐步法Logistic回归分析筛查术后行脑室-腹腔分流术的危险因素。结果约7.54%（15/199）患儿术后需行脑室-腹腔分流术，其中14/15例为术后2周内新发脑积水或原有脑积水进展。Logistic回归分析显示，术前存在脑积水（OR=14.756，95% CI：3.451~63.089；P=0.000）、肿瘤邻近中线（OR=5.466，95% CI：1.409～21.203；P=0.014）、术中出血量大（OR=1.295，95% CI：1.016~1.650；P=0.037）是幕上肿瘤患儿手术后需行脑室-腹腔分流术的危险因素。结论幕上肿瘤切除术后并发脑积水或原有脑积水进展主要发生于术后2周内，对于术前合并脑积水、肿瘤邻近中线和术中出血量大的患儿应警惕术后新发脑积水或原有脑积水急性进展。

关键词: 幕上肿瘤, 脑积水, 脑室腹膜分流术, 危险因素, Logistic模型, 儿童

GUO Zhong-yin, PENG Peng, CHEN Zi-rong, ZHANG Xiao-lin, DONG Min-hai, ZENG Kuo, WAN Li-jun, XIANG Wang, WAN Feng. Risk factors analysis of ventriculoperitoneal shunt after supratentorial neoplasms surgery in children[J]. Chinese Journal of Contemporary Neurology and Neurosurgery, 2023, 23(5): 412-417.

郭中印, 彭鹏, 陈籽荣, 张晓琳, 董民海, 曾括, 万丽君, 向网, 万锋. 幕上肿瘤患儿手术后行脑室-腹腔分流术危险因素分析[J]. 中国现代神经疾病杂志, 2023, 23(5): 412-417.

/ / Recommend / Download Citations

URL: http://journal11.magtechjournal.com/cjcnn/EN/10.3969/j.issn.1672-6731.2023.05.006

http://journal11.magtechjournal.com/cjcnn/EN/Y2023/V23/I5/412

References

[1] Miller KD, Ostrom QT, Kruchko C, Patil N, Tihan T, Cioffi G, Fuchs HE, Waite KA, Jemal A, Siegel RL, Barnholtz-Sloan JS. Brain and other central nervous system tumor statistics, 2021[J]. CA Cancer J Clin, 2021, 71:381-406.
[2] Hossain MJ, Xiao W, Tayeb M, Khan S. Epidemiology and prognostic factors of pediatric brain tumor survival in the US:evidence from four decades of population data[J]. Cancer Epidemiol, 2021, 72:101942.
[3] Pollack IF, Agnihotri S, Broniscer A. Childhood brain tumors:current management, biological insights, and future directions[J]. J Neurosurg Pediatr, 2019, 23:261-273.
[4] Ghajar-Rahimi G, Kang KD, Totsch SK, Gary S, Rocco A, Blitz S, Kachurak K, Chambers MR, Li R, Beierle EA, Bag A, Johnston JM, Markert JM, Bernstock JD, Friedman GK. Clinical advances in oncolytic virotherapy for pediatric brain tumors[J]. Pharmacol Ther, 2022, 239:108193.
[5] Alois CI, Luntz A. Recognizing and managing hydrocephalus in children[J]. JAAPA, 2023, 36:18-26.
[6] Riva-Cambrin J, Kulkarni AV, Burr R, Rozzelle CJ, Oakes WJ, Drake JM, Alvey JS, Reeder RW, Holubkov R, Browd SR, Cochrane DD, Limbrick DD, Naftel R, Shannon CN, Simon TD, Tamber MS, McDonald PJ, Wellons JC, Luerssen TG, Whitehead WE, Kestle JRW. Impact of ventricle size on neuropsychological outcomes in treated pediatric hydrocephalus:an HCRN prospective cohort study[J]. J Neurosurg Pediatr, 2021.[Epub ahead of print]
[7] Tully HM, Doherty D, Wainwright M. Mortality in pediatric hydrocephalus[J]. Dev Med Child Neurol, 2022, 64:112-117.
[8] Foreman P, McClugage S 3rd, Naftel R, Griessenauer CJ, Ditty BJ, Agee BS, Riva-Cambrin J, Wellons J 3rd. Validation and modification of a predictive model of postresection hydrocephalus in pediatric patients with posterior fossa tumors[J]. J Neurosurg Pediatr, 2013, 12:220-226.
[9] Gopalakrishnan CV, Dhakoji A, Menon G, Nair S. Factors predicting the need for cerebrospinal fluid diversion following posterior fossa tumor surgery in children[J]. Pediatr Neurosurg, 2012, 48:93-101.
[10] Santos de Oliveira R, Barros Jucá CE, Valera ET, Machado HR. Hydrocephalus in posterior fossa tumors in children:are there factors that determine a need for permanent cerebrospinal fluid diversion[J]? Childs Nerv Syst, 2008, 24:1397-1403.
[11] Helmbold LJ, Kammler G, Regelsberger J, Fritzsche FS, Emami P, Schüller U, Krajewski K. Predictive factors associated with ventriculoperitoneal shunting after posterior fossa tumor surgery in children[J]. Childs Nerv Syst, 2019, 35:779-788.
[12] Riva-Cambrin J, Detsky AS, Lamberti-Pasculli M, Sargent MA, Armstrong D, Moineddin R, Cochrane DD, Drake JM. Predicting postresection hydrocephalus in pediatric patients with posterior fossa tumors[J]. J Neurosurg Pediatr, 2009, 3:378-385.
[13] Bell H, Ownsworth T, Lloyd O, Sheeran N, Chambers S. A systematic review of factors related to children's quality of life and mental health after brain tumor[J]. Psychooncology, 2018, 27:2317-2326.
[14] Corti C, Urgesi C, Massimino M, Gandola L, Bardoni A, Poggi G. Effects of supratentorial and infratentorial tumor location on cognitive functioning of children with brain tumor[J]. Childs Nerv Syst, 2020, 36:513-524.
[15] Missori P, Rughetti A, Peschillo S, Gualdi G, Di Biasi C, Nofroni I, Marinelli L, Fattapposta F, Currà A. In normal aging ventricular system never attains pathological values of Evans' index[J]. Oncotarget, 2016, 7:11860-11863.
[16] Cogswell PM, Graff-Radford J, Wurtz LI, Graff-Radford NR, Johnson DR, Hunt CH, Gunter JL, Cutsforth-Gregory JK, Jones DT, Elder BD, Huston Iii J, Jack CR Jr. CSF dynamics disorders:association of brain MRI and nuclear medicine cisternogram findings[J]. Neuroimage Clin, 2020, 28:102481.
[17] Hu SQ, Guo ZY, Wan LJ, Chen ZR, Wan F. Blood loss in operation is independently predictive of postoperative ventriculoperitoneal shunt in pediatric patients with posterior fossa tumors[J]. Pediatr Neurol, 2023, 144:119-125.[Epub ahead of print]
[18] Sevensky R, Newville JC, Tang HL, Robinson S, Jantzie LL. Cumulative damage:cell death in posthemorrhagic hydrocephalus of prematurity[J]. Cells, 2021, 10:1911.
[19] Karimy JK, Zhang J, Kurland DB, Theriault BC, Duran D, Stokum JA, Furey CG, Zhou X, Mansuri MS, Montejo J, Vera A, DiLuna ML, Delpire E, Alper SL, Gunel M, Gerzanich V, Medzhitov R, Simard JM, Kahle KT. Inflammation-dependent cerebrospinal fluid hypersecretion by the choroid plexus epithelium in posthemorrhagic hydrocephalus[J]. Nat Med, 2017, 23:997-1003.
[20] Hochstetler A, Raskin J, Blazer-Yost BL. Hydrocephalus:historical analysis and considerations for treatment[J]. Eur J Med Res, 2022, 27:168.
[21] Murtha LA, Yang Q, Parsons MW, Levi CR, Beard DJ, Spratt NJ, McLeod DD. Cerebrospinal fluid is drained primarily via the spinal canal and olfactory route in young and aged spontaneously hypertensive rats[J]. Fluids Barriers CNS, 2014, 11:12.

Please choose a citation manager

Content to export