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Spontaneous shunt independence in paediatric tumour-related hydrocephalus: case series and review of the literature

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Abstract

Purpose

Hydrocephalus is commonly associated with paediatric posterior fossa tumours and their resection. This is commonly managed by ventriculoperitoneal shunt insertion, which is associated with a lifelong risk of malfunction, necessitating revisional surgery. Few opportunities ever arise for the patient to be free of the shunt and this risk. We describe three patients shunted for tumour-related hydrocephalus who subsequently developed spontaneous shunt independence. We discuss this in the context of the literature.

Methods

A single-centre retrospective case series analysis was performed using a departmental database. Case notes were retrieved from a local electronic records database, and images were reviewed using national Picture Archiving and Communication Systems.

Results

Over a 10-year period, 28 patients underwent ventriculoperitoneal shunt insertion for tumour-related hydrocephalus. Of these, 3 patients (10.7%) went on to have their shunts successfully removed. Age at presentation varied from 1 to 16 years. In all cases, the patient required shunt externalization due to shunt or intra-abdominal infection. This was used as an opportunity to challenge the need for ongoing cerebrospinal fluid (CSF) diversion. In one case, this occurred only several months after a shunt blockage with intracranial pressure monitoring that proved her shunt dependence. All three patients tolerated this challenge, their shunt systems were removed without complication, and they remain free of hydrocephalus at last follow-up.

Conclusion

These cases reflect our poor understanding of the heterogenous physiology of patients with shunted hydrocephalus and underline the importance of challenging the need for CSF diversion at any appropriate opportunity.

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Author notes

  1. Giulia Bankov and Michael D. Cearns have equal contribution.

Authors and Affiliations

  1. Department of Paediatric Neurosurgery, Royal Hospital for Children, 1345 Govan Road, Glasgow, G51 4TF, UK

    G. Bankov, M. D. Cearns, A. Amato-Watkins & E. Campbell

Authors
  1. G. Bankov
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  2. M. D. Cearns
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  3. A. Amato-Watkins
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  4. E. Campbell
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Contributions

Conceptualisation: all. Data curation: all. Writing — original draft: GB, MDC. Writing — review and editing: MDC, AAW, EC. Visualization: MDC. Project administration: MDC. Supervision: MDC, AAW, EC.

Corresponding author

Correspondence to M. D. Cearns.

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This study was a retrospective and anonymised review of case notes and therefore an ethical review process was not sought.

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The authors have no financial or non-financial interests to disclose.

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Bankov, G., Cearns, M.D., Amato-Watkins, A. et al. Spontaneous shunt independence in paediatric tumour-related hydrocephalus: case series and review of the literature. Childs Nerv Syst 39, 3179–3184 (2023). https://doi.org/10.1007/s00381-023-05995-0

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  • DOI: https://doi.org/10.1007/s00381-023-05995-0

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