Hydrocephalus and infratentorial tumors

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Abstract
The child with hydrocephalus complicating a primary brain tumor may be considered to have 2 distinctly different diseases: a neoplasm and hydrocephalus. The hydrocephalus may be obstructive, communicating or (in choroid plexus papilloma) hypersecretory. The incidence, symptomatology and management of hydrocephalus associated with infratentorial brain tumors in 156 children and with pineal tumors in 21 children are presented. Medulloblastoma was the most commonly encountered tumor. Of 117 children with cerebellar-4th ventricle tumors, 110 had hydrocephalus; 11 of 34 with brain-stem tumors and all 21 with pineal tumors presented with hydrocephalus. Of the 143 patients with hydrocephalus, 123 patients had shunts inserted 1-21 days before craniotomy. Eighteen of these children required shunt revisions after craniotomy; 36 of 80 patients followed for 6 mo. or more had their shunts permanently removed, but in 30% of these the shunt was reinserted from 5 days-13 mo. later. Only 25 patients remained permanently shunt-free. The placement of shunts before craniotomy is justified by the extraordinarily high incidence of papilledema and visual impairment associated with hydrocephalus. Upward herniation and dissemination of neoplastic cells through the shunting system are theoretical contraindications to precraniotomy shunt insertion although the former is rare (3%) and there is no statistical evidence to support the latter.