Prognostic Factors of Hydrocephalus in Children with Brain Tumors: A Retrospective Analysis

Background/Objectives: Hydrocephalus is one of the main complications of brain tumors in children, involving about 50% of cases at diagnosis. It usually resolves with surgical tumor resection but could persist up to 10-40% of cases. The aim of this study is to identify prognostic factors associated with persistent hydrocephalus in a pediatric population of patients with brain tumors. Design/Methods: Retrospective case note review of 56 newly diagnosed brain tumour patients referred between 04/2012 and 01/2018 to our regional paediatric neuro-oncology ser- vice was carried out to evaluate preoperative and postoper- ative Magnetic Resonance Imaging (MRI) and to determine Evans’ Index (EI) and fronto-occipital horn ratio (FOHR) for each scan. Chi-square and Fischer test were used to analyze categorical variables as appropriate. Mann-Whitney analysis was used for the evaluation of continuous variables. A p-value <0.05 was considered significant. Results: Data on fifty-six children were analyzed: 30 males (54%), mean age at diagnosis 9.03 (SD ± 4.11 years). Anatomical distribution was sovratentorial 21/56 (37.5%), subtentorial 35/56 (62.5%). MRI reported the presence of radiological hydrocephalus in 25/56 children (45%) at diag- nosis; 9/25 children (36%) had persistent hydrocephalus in the post-operative phase. The previous presence of an external ventricular drain (p: 0.028) and a FOHR> 0.46 at diagnosis (p: 0.042) were related to a higher prevalence of persistent hydrocephalus and therefore to the need for a cerebrospinal fluid drain device. Conclusions: Identifying pre-operatively patients at risk for developing persistent hydrocephalus would avoid delays in the execution of interventions for the placement of perma- nent cerebrospinal fluid drain devices. This study finds that a FOHR> 0.46 at diagnosis could impact on the therapeu- tic management of children with hydrocephalus and brain tumors. Prospective and large-scale studies are needed in order to standardize this approach.