Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Feb;171(3):681-689.
doi: 10.1007/s11060-024-04890-1. Epub 2024 Nov 28.

Transient and permanent hydrocephalus following resection of brain metastases located in the posterior fossa: incidence, risk factors and the necessity of perioperative external ventricular drainage placement

Ehab Shabo  1 , Anna-Laura Potthoff  2 , Thomas Zeyen  3 , Julian P Layer  4   5 , Stefan Ehrentraut  6 , Jasmin Scorzin  2 , Felix Lehmann  6 , Nils Christian Lehnen  7 , Mohammed Banat  2 , Johannes Weller  3 , Florian Gessler  8 , Daniel Paech  7 , Motaz Hamed  2 , Valeri Borger  2 , Alexander Radbruch  7 , Ulrich Herrlinger  3 , Leonie Weinhold  9 , Hartmut Vatter  2 , Matthias Schneider  2
Affiliations

Transient and permanent hydrocephalus following resection of brain metastases located in the posterior fossa: incidence, risk factors and the necessity of perioperative external ventricular drainage placement

Ehab Shabo et al. J Neurooncol. 2025 Feb.

Abstract

Purpose: Prophylactic insertion of an external ventricular drainage (EVD) prior to the resection of posterior fossa metastases (PFMs) is a common approach to address postoperative transient and permanent hydrocephalus. However, predicting surgery-related hydrocephalus in the preoperative phase continues to be a challenge. This study aims to analyze the incidence, preoperatively collectable risk factors and necessity of perioperative external ventricular drainage placement after posterior fossa metastasis surgery.

Methods: All patients undergoing surgery for PFMs at the authors' neuro-oncological center between 2015 and 2021 were identified and assessed for postoperative hydrocephalus occurrence. Tumour volume, edema volume, and 4th ventricle volume were assessed on preoperative magnetic resonance imaging scans using the IntelliSpace Portal 5.0. A multivariable logistic regression analysis was performed to identify possible predictors for postoperative hydrocephalus occurrence.

Results: Postoperative hydrocephalus occurred in 14 of the 130 identified PFM patients (11%). Multivariable analysis and receiver operating characteristic (ROC) analysis revealed a 4th -ventricle-to-tumor-volume ratio ≤ 0.02 (OR 33.1, 95% CI 3.8-284.3, p = 0.001), an edema-to- tumor-volume ratio ≤ 0.85 (OR 10.6, 95% CI 2.4-47.4, p = 0.002), an imaging-morphological contact to the 4th ventricle (OR 5, 95% CI 1.4-18, p = 0.013), and multiple intracranial metastases (OR 2.4, 95% CI 1-5.9, p = 0.045) as independent predictors for surgery-related postoperative hydrocephalus occurrence.

Conclusion: The present study identifies preoperatively detectable risk factors for the occurrence of postoperative hydrocephalus following surgery for PFMs. These findings may provide guidance in clinical decision-making regarding prophylactic EVD placement.

Keywords: External ventricular drainage; Posterior fossa metastasis; Postoperative hydrocephalus.

PubMed Disclaimer

Conflict of interest statement

Declarations. Ethics approval: This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of the University Hospital Bonn (No. 250/19). Consent to participate: Informed consent was not sought as a retrospective study design was used. Consent to publish: All authors agreed to the publication of the manuscript. Previous publication: None. Previous presentations: Data included in this manuscript have been presented in part at the 75h national day of Deutsche Gesellschaft für Neurochirurgie/German Society of Neurosurgery (DGNC) in Göttingen 06/2024 and sections day of Sektionstagung Deutsche Gesellschaft für Neurochirurgie/German Society of Neurosurgery (DGNC) 09/2024. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
ROC-analysis demonstrating the cut off values for (A) the 4th ventricle-to-tumor-volume ratio (≤ 0.02, sensitivity 92% and specificity 81%) and (B) the edema-to-tumor-volume ratio (≤ 0.85, sensitivity 71.4% and specificity 89.7%)
Fig. 2
Fig. 2
ROC-analysis evaluating the statistical predictive value of the risk factors identified for postoperative hydrocephalus
Fig. 3
Fig. 3
Alluvial plot of identified risk factors for postoperative hydrocephalus occurrence
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Villano JL et al (2015) Incidence of brain metastasis at initial presentation of lung cancer. Neuro Oncol 17(1):122–128 - PMC - PubMed
    1. Davis FG et al (2012) Toward determining the lifetime occurrence of metastatic brain tumors estimated from 2007 United States cancer incidence data. Neuro Oncol 14(9):1171–1177 - PMC - PubMed
    1. Ghia A et al (2007) Distribution of brain metastases in relation to the hippocampus: implications for neurocognitive functional preservation. Int J Radiat Oncol Biol Phys 68(4):971–977 - PubMed
    1. Delattre JY et al (1988) Distribution of brain metastases. Arch Neurol 45(7):741–744 - PubMed
    1. Mahajan A et al (2017) Post-operative stereotactic radiosurgery versus observation for completely resected brain metastases: a single-centre, randomised, controlled, phase 3 trial. Lancet Oncol 18(8):1040–1048 - PMC - PubMed

MeSH terms

LinkOut - more resources