Management of SecondaryHydrocephalus Associated with Posterior Fossa Lesions in Children (Different Modalities of Treatment)

Background: Posterior fossa is a common site for various tumors to occur during childhood. It is estimated that they comprise 54-60% of childhood brain tumors .The proximity to the fourth ventricle and therefore CSF pathways predisposes patients with posterior fossa tumors to the development of obstructive hydrocephalus (HCP). Therefore, some patients with posterior fossa tumors will require a cerebrospinal fluid diversion procedure at some time during the course of their illness. Objective: The aim of this study is to analyze the different modalities used in the perioperative management of hydrocephalus associated with posterior fossa tumors in pediatric patients. Patients and Methods: 30 cases diagnosed as posterior fossa tumor and secondary hydrocephalus treated at Ain Shams University Hospitals were retrospectively evaluated regarding different modalities in manegement. The manegement varied from V-P shunt to endoscopic third ventriculostomy or direct tumor exicion. Results: In Ventriculoperitoneal shunt (ten patients), two mortality cases (20%), clinical improvement (as regard Increase ICP manifestation) occurred in mean period 1.8±1.3 days. Postoperative decrease in Evan s ratio in relation to preoperative value is very highly significant. (P=0.00006) In Endoscopic third ventriculostomy (eight patients), one mortality case (12.5%), clinical improvement (as regard Increase ICP manifestation) occurred in mean period 4.8±3.5 days. Postoperative decrease in Evan s Ratio in relation to preoperative value is significant (P=0.0116) .In Direct tumor surgery with or without external ventricular drain (EVD) (twelve patients), two mortality cases (16.7%) died from postoperative hydrocephalus without using EVD. Clinical improvement (as regard Increase ICP manifestation) occurred in mean period 2.7±1.9 days. Postoperative decrease in Evan s Ratio in relation to preoperative value is very highly significant. (P=0.00006). Conclusion: While managing the hydrocephalus associated with posterior fossa lesions, endoscopic third ventriculostomy should be considered first .When choosing to directly attack the tumor, an external ventricular drain should be applied. Site of the tumor and degree of resection are predictive factors for the need of post-operative shunt in patients with direct tumoral attack.