Cerebrospinal fluid diversion prior to posterior fossa tumor resection in adults: A systematic review

Amisha Vastani; Asfand Baig Mirza; Fizza Ali; Allayna Iqbal; Chaitanya Sharma; Abbas Khizar Khoja; Babar Vaqas; José Pedro Lavrador; Jonathan Pollock

doi:10.1093/nop/npae055

Cerebrospinal fluid diversion prior to posterior fossa tumor resection in adults: A systematic review

Neurooncol Pract. 2024 Jun 20;11(6):703-712. doi: 10.1093/nop/npae055. eCollection 2024 Dec.

Authors

Amisha Vastani¹, Asfand Baig Mirza¹, Fizza Ali², Allayna Iqbal², Chaitanya Sharma², Abbas Khizar Khoja², Babar Vaqas¹, José Pedro Lavrador³, Jonathan Pollock¹

Affiliations

¹ Department of Neurosurgery, Queens Hospital, Romford, UK.
² GKT School of Medical Education, King's College London, London, UK.
³ Department of Neurosurgery, Kings College Hospital NHS Foundation Trust, Denmark Hill, UK.

PMID: 39554780
PMCID: PMC11567752 (available on 2025-06-20)
DOI: 10.1093/nop/npae055

Abstract

Background: Posterior fossa tumors (PFTs) comprise 15%-20% of adult brain tumors, with the reported frequency of hydrocephalus (HCP) ranging between 3.7% and 58%. Most HCP resolves after resection of PFTs, but studies report persistent or new-onset HCP occurring in between 2% and 7% of cases. Preoperative cerebrospinal fluid (CSF) diversion with a ventriculoperitoneal shunt (VPS), external ventricular drain (EVD), or endoscopic third ventriculostomy (ETV) has been shown to improve outcomes. Evidence regarding the efficacy of these techniques is limited.

Methods: A systematic literature search was performed in line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Data points were extracted from individual patient cohort data. A failure rate was determined by the number of patients requiring further postoperative CSF diversion.

Results: In total, 8863 records were identified. Thirteen studies consisting of 17 patient cohorts met our inclusion criteria. Across all individual cohort studies, 2976 patients underwent surgical resection of a PFT in whom the frequency of hydrocephalus at presentation was 22.98% (1.92%-100%), and persistent hydrocephalus following preoperative CSF diversion was 13.63% (0%-18%). Of the 684 hydrocephalic patients, 83.63% underwent CSF diversion in the form of ETV, EVD, or VPS. Between years 1992 and 2020, 1986 and 2021, and 1981and 2013, the pre-resection ETV, EVD, and VPS failure rates were 14.66% (17/116), 16.26% (60/369), and 0% (0/87), respectively.

Conclusions: This systematic review highlights that VPS has a better failure rate profile in minimizing postoperative hydrocephalus in adult patients with PFTs.

Keywords: CSF diversion; EVD; VPS; hydrocephalus; posterior fossa tumor.

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