management of hydrocephalus in posterior cranial fossa tumors

treatment of hydrocephalus in posterior fossa tumors in children is still a matter of controversy and different centers have their own routines. in this regard, hospital records of all children with posterior fossa tumors treated in our center during the interval of 1985-1995 were reviewed. patients’ demographic and diagnostic data were analyzed and the frequencies of shunting procedures were determined. fisher exact test was employed to compare the frequency of postoperative complications in different groups. a total of 108 patients with age ranging from 3 months to 18 years and a male to female ratio of 1.5 comprised the study population. ninety-nine cases had hydrocephalus at the time of diagnosis and 81 patients underwent preoperative shunting. of the remaining 18 patients, 13 underwent external ventricular drainage at tumor operation session plus preoperative corticosteroid therapy. the rest of the patients got no primary treatment for hydrocephalus. three of these 5 patients had postoperative shunting after tumor removal, but the other 2 remained shunt free. the rate of postoperative complications including cerebrospinal fluid leakage and septic meningitis were significantly lower in patients with preoperative shunting. the results of this study are in favor of those that approve the effect of preoperative shunting in decreasing postoperative complications. this is well established when the tumor size is big or when the diagnosis of posterior fossa tumor is made in later stages or when hydrocephalus is severe. it could be concluded that preoperative shunting can decrease the rate of postoperative complications.