Understanding the role of neuroendoscopy for treatment of hydrocephalus in adults with intracranial mass lesions: a case series.

Objective

Hydrocephalus can result from mass lesions for several reasons. Due to limited numbers of adult patients with mass lesions in studies that examine outcomes of endoscopic third ventriculostomy, success in this population is unclear. Additionally, the role of other ventriculoscopic procedures in the management of associated hydrocephalus is unclear. In this retrospective case series, the authors investigated optimal management strategies for patients with mass lesions and hydrocephalus.

Methods

A list of patients who underwent ventriculoscopic procedures or shunting procedures was compiled. Basic demographics, pathology, etiology of hydrocephalus, imaging, surgical procedures, complications, and long-term outcomes were obtained from the electronic medical record. Patients were subanalyzed in groups based on pathology, type of hydrocephalus, and initial management strategy.

Results

A total of 98 patients were identified. The most common pathologies causing hydrocephalus were gliomas, (n = 33, 33.67%), metastatic lesions (n = 17, 17.35%), pineal region tumors (n = 13, 13.27%), and cystic lesions (n = 13, 13.27%). Colloid cysts were excluded. Obstructive hydrocephalus was the most common cause of hydrocephalus (n = 102, 81.60%). All patients who presented with communicating hydrocephalus were treated with shunting. The long-term success of endoscopic approaches was 83.33%. Patients with gliomas and CNS lymphoma were least likely to be shunt free after endoscopic management.

Conclusions

The etiology of hydrocephalus in patients with mass lesions is heterogeneous. Shunting is effective in patients with communicating hydrocephalus. Endoscopic management is successful in patients with obstructive hydrocephalus if their tumors do not have a propensity for leptomeningeal disease, such as high-grade gliomas or CNS lymphoma.