The Natural History of Ventriculomegaly and Tonsillar Herniation in Children with Posterior Fossa Tumours – An MRI Study
| العنوان: | The Natural History of Ventriculomegaly and Tonsillar Herniation in Children with Posterior Fossa Tumours – An MRI Study |
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| المؤلفون: | Jesus Lafuente, William Harkness, Kanna K. Gnanalingham, Dominic Thompson, Richard D. Hayward |
| المصدر: | Pediatric Neurosurgery. 39:246-253 |
| بيانات النشر: | S. Karger AG, 2003. |
| سنة النشر: | 2003 |
| مصطلحات موضوعية: | Male, medicine.medical_specialty, Hernia, Adolescent, Infratentorial Neoplasms, Ventriculoperitoneal Shunt, Cerebral Ventricles, Central nervous system disease, Cerebrospinal fluid, medicine, Humans, Child, Cerebrospinal Fluid, Retrospective Studies, medicine.diagnostic_test, business.industry, Infant, Newborn, Infant, Magnetic resonance imaging, General Medicine, medicine.disease, Magnetic Resonance Imaging, nervous system diseases, Surgery, Hydrocephalus, Natural history, Child, Preschool, Infratentorial Neoplasm, Adenoids, Pediatrics, Perinatology and Child Health, Disease Progression, Female, Neurology (clinical), business, Ventriculomegaly |
| الوصف: | Objective: Posterior fossa tumours in children predispose to hydrocephalus, although the natural history is unclear and the need for drainage of the ventricles is controversial. We report on the natural history of ventriculomegaly and tonsillar herniation, as seen on serial MRI scans in children with posterior fossa tumours. Results: Eighty-nine children with posterior fossa tumours were reviewed retrospectively. Overall, 18 (20%) patients required permanent cerebrospinal fluid (CSF) drainage in the form of a ventriculoperitoneal shunt (n = 15) or third ventriculostomy (n = 3). On pre-operative MRI scan, the ventricular size was assessed by measurement of the ventricular index (VI) and 59 patients (66%) had a VI greater than 0.4. There was a progressive decrease in the mean VI from pre-operative to post-operative MRI scans and beyond 3–9 months after surgery, the mean VI was less than 0.4 (p = 0.0001). Patients requiring permanent CSF drainage had a greater VI pre-operatively and at 3–9 months post-operatively (p < 0.05). On pre-operative MRI scan, 75 patients (84%) had greater than 5 mm herniation of the cerebellar tonsils below the level of the foramen magnum. There was a progressive decrease in the mean tonsillar herniation from pre-operative to post-operative MRI scans, with time (p = 0.0001), although this did not relate to the need for CSF drainage. On multivariate analysis, the need for permanent CSF drainage was associated with pre- and intra-operative CSF drainage (odds ratio = 23.3; p = 0.0001) and incomplete surgical excision of tumour (odds ratio = 7.7; p = 0.006). Conclusions: Hydrocephalus and tonsillar herniation are common in children with posterior fossa tumours, although post-operatively there is a natural tendency for it to resolve and only a fifth of the patients needed permanent CSF drainage. We recommend selective drainage of CSF in children with posterior fossa tumours. Patients at risk are those with severe symptoms at presentation, needing peri-operative CSF drainage and those with subtotal resection of tumour. |
| تدمد: | 1423-0305 1016-2291 |
| الوصول الحر: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::cacf393c4eda7f8b388281b250a8773fTest https://doi.org/10.1159/000072869Test |
| حقوق: | CLOSED |
| رقم الانضمام: | edsair.doi.dedup.....cacf393c4eda7f8b388281b250a8773f |
| قاعدة البيانات: | OpenAIRE |
| تدمد: | 14230305 10162291 |
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