Post-operative hydrocephalus and pseudomeningocele is a frequent scenario after posterior fossa surgery that often conditions timing of adjuvant treatments. Molecular subgrouping in medulloblastoma (MB) has shown relevant prognostic and therapeutic significance. However, little information is available about the possibility of different surgical outcomes depending on MB subgrouping. We report our series of 35 consecutive MB patients treated at the Bambino Gesù Children's Hospital from 2011 to 2016. Molecular subgroup was available in 29 cases. We retrospectively reviewed CSF related complications in this population and analyzed possible association to molecular subgroups. Whenever clinically indicated we performed a preoperative endoscopic ventriculostomy to improve CSF circulation. External ventricular drainage was never used in our series. Twenty-four patients (83%) presented with ventriculomegaly and 17 (59%) had symptomatic hydrocephalus. Fifteen patients were treated with endoscopic ventriculostomy before respective surgery. After surgery, 23 (79%) children had a subcutaneous CSF collection, mostly resolving spontaneously. In fact, only 7 (30%) of them required treatment for their pseudomeningocele. Treatments included lumbar puncture, needle evacuation of subcutaneous collection, wound revision. VP shunt was necessary in 3 patients (10% of total population, 13% of children showing post-operative subcutaneous collection). Need to treat the subcutaneous CSF collection was significantly conditioned by molecular subgroup (4 patients were group 3, 2 patients group 4 and 1 patient SHH). Patients requiring a VP shunt belonged to either group 3 or 4. Our data suggest that post-operative hydrocephalus might be associated to specific molecular subgroups in MB patients.
IMPACT OF MEDULLOBLASTOMA MOLECULAR SUBGROUP ON POST-OPERATIVE PSEUDOMENINGOCELE AND NEED FOR VENTRICULAR SHUNTING
Raffaella Messina;
2016-01-01
Abstract
Post-operative hydrocephalus and pseudomeningocele is a frequent scenario after posterior fossa surgery that often conditions timing of adjuvant treatments. Molecular subgrouping in medulloblastoma (MB) has shown relevant prognostic and therapeutic significance. However, little information is available about the possibility of different surgical outcomes depending on MB subgrouping. We report our series of 35 consecutive MB patients treated at the Bambino Gesù Children's Hospital from 2011 to 2016. Molecular subgroup was available in 29 cases. We retrospectively reviewed CSF related complications in this population and analyzed possible association to molecular subgroups. Whenever clinically indicated we performed a preoperative endoscopic ventriculostomy to improve CSF circulation. External ventricular drainage was never used in our series. Twenty-four patients (83%) presented with ventriculomegaly and 17 (59%) had symptomatic hydrocephalus. Fifteen patients were treated with endoscopic ventriculostomy before respective surgery. After surgery, 23 (79%) children had a subcutaneous CSF collection, mostly resolving spontaneously. In fact, only 7 (30%) of them required treatment for their pseudomeningocele. Treatments included lumbar puncture, needle evacuation of subcutaneous collection, wound revision. VP shunt was necessary in 3 patients (10% of total population, 13% of children showing post-operative subcutaneous collection). Need to treat the subcutaneous CSF collection was significantly conditioned by molecular subgroup (4 patients were group 3, 2 patients group 4 and 1 patient SHH). Patients requiring a VP shunt belonged to either group 3 or 4. Our data suggest that post-operative hydrocephalus might be associated to specific molecular subgroups in MB patients.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
