Challenges in cerebrospinal fluid shunting in patients with glioblastoma

摘要

Cerebrospinal fluid (CSF) circulation disturbances may occur during the course of disease in patients with glioblastoma. Ventriculoperitoneal shunting has generally been recommended to improve symptoms in glioblastoma patients. Shunt implantation for patients with glioblastoma, however, presents as a complex situation and produces different problems to shunting in other contexts. Information on complications of shunting glioma patients has rarely been the subject of investigation. In this retrospective study, we analysed restropectively the course and outcome of glioblastoma-related CSF circulation disturbances after shunt management in a consecutive series of patients within a period of over a decade. Thirty of 723 patients with histopathologically-confirmed glioblastoma diagnosed from 2002 to 2016 at the Department of Neurosurgery, Hannover Medical School, underwent shunting for CSF circulation disorders. Treatment history of glioblastoma and all procedures associated with shunt implementation were analyzed. Data on follow-up, time to progression and survival rates were obtained by review of hospital charts and supplemented by phone interviews with the patients, their relations or the primary physicians. Mean age at the time of diagnosis of glioblastoma was 43?years. Five types of CSF circulation disturbances were identified: obstructive hydrocephalus (n?=?9), communicating hydrocephalus (n?=?15), external hydrocephalus (n?=?3), trapped lateral ventricle (n?=?1), and expanding fluid collection in the resection cavity (n?=?2). All patients showed clinical deterioration. Procedures for CSF diversion were ventriculoperitoneal shunt (n?=?21), subduroperitoneal shunt (n?=?3), and cystoperitoneal shunt (n?=?2). In patients with lower Karnofsky Performance Score (KPS) (