Risk Factors of Persistent Hydrocephalus in Children with Brain Tumor: A Retrospective Analysis

Abstract

&lt;b&gt;&lt;i&gt;Object:&lt;/i&gt;&lt;/b&gt; Hydrocephalus is one of the main complications of brain tumors in children, being present in about 50% of cases at the time of the tumor diagnosis and persisting up to 10–40% of cases after surgical resection. This is a single-institution retrospective study on the variables that may predict the need for treatment of persistent hydrocephalus in pediatric patients presenting with a brain tumor. &lt;b&gt;&lt;i&gt;Methods:&lt;/i&gt;&lt;/b&gt; Retrospective case note review of 43 newly diagnosed brain tumors in children referred between April 2012 and January 2018 to our regional pediatric neuro-oncology service was carried out. Diagnosis of hydrocephalus was carried out using both preoperative and postoperative MRI to determine Evans’ index (EI) and the fronto-occipital horn ratio (FOHR) from each scan. Simple logistic regression was used to analyze categorical variables as appropriate. A &lt;i&gt;p&lt;/i&gt; value &amp;#x3c;0.05 was considered significant. &lt;b&gt;&lt;i&gt;Results:&lt;/i&gt;&lt;/b&gt; Forty-three children were analyzed, 26 males and 17 females with a median age at diagnosis 10.4 years (IQR: 5.2–13.5). Hydrocephalus was present in 22/43 children (51%) preoperatively; in 8/22 children (36%) with hydrocephalus undergoing tumor resection, hydrocephalus persisted also in the postoperative period. An EI &amp;#x3e;0.34 (&lt;i&gt;p&lt;/i&gt; = 0.028) and an FOHR &amp;#x3e;0.46 (&lt;i&gt;p&lt;/i&gt; = 0.05) before surgery were associated with a higher prevalence of persistent hydrocephalus and therefore to the need for a cerebrospinal fluid drain device in the postoperative phase. &lt;b&gt;&lt;i&gt;Conclusion:&lt;/i&gt;&lt;/b&gt; Preoperative identification of children at risk for developing persistent hydrocephalus would avoid delays in planning the permanent cerebrospinal fluid drain devices. This study finds that an EI &amp;#x3e;0.34 and an FOHR &amp;#x3e;0.46 at diagnosis could impact on the therapeutic management of children with hydrocephalus associated with brain tumors. Prospective and larger-scale studies are needed to standardize this approach. </jats:p