Molecular subgroup of medulloblastoma: evaluation of contribution to CSF diversion following tumour resection

Introduction Medulloblastoma is the commonest malignant brain tumour in children. Pre-operative hydrocephalus is present in up to 90% of these patients at presentation. Following posterior fossa surgery, despite resolution of fourth ventricular obstruction, a proportion of these children will still...

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Published in:Child's nervous system 2023-03, Vol.39 (3), p.563-568
Main Authors: Afshari, Fardad T., Toescu, Sebastian, Baig, Rehman Ali, Ong, John, Lee, Keng Siang, Cheng, Kevin King-Fai, Solanki, Guirish A., Lo, William B., Aquilina, Kristian
Format: Article
Language:English
Subjects:
Brain Neoplasms - surgery
Cerebellar Neoplasms - genetics
Cerebellar Neoplasms - surgery
Child
Clinical Paper
Female
Humans
Hydrocephalus - epidemiology
Hydrocephalus - etiology
Hydrocephalus - surgery
Male
Medicine
Medicine & Public Health
Medulloblastoma - genetics
Medulloblastoma - surgery
Neurosciences
Neurosurgery
Retrospective Studies
Ventriculoperitoneal Shunt
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Summary:Introduction Medulloblastoma is the commonest malignant brain tumour in children. Pre-operative hydrocephalus is present in up to 90% of these patients at presentation. Following posterior fossa surgery, despite resolution of fourth ventricular obstruction, a proportion of these children will still require cerebrospinal fluid (CSF) diversion for management of persistent or new hydrocephalus. Various scoring systems have been developed to predict the risk for CSF diversion following posterior fossa surgery. However, no accurate tool exists regarding which pathological subset or group of medulloblastoma patients will require a shunt post-operatively. In this study we investigated the impact of molecular subgroup of medulloblastoma on shunt dependency post-operatively in paediatric patients. Methods We undertook a retrospective multi-centre study of children with medulloblastoma who underwent tumour resection. Those with available molecular subgroup were identified. Demographic data and clinical parameters including age, sex, presence of pre-operative hydrocephalus, extent of surgical resection, evidence of metastasis/leptomeningeal disease and need for CSF diversion post-operatively were further analysed. Results Sixty-nine children with medulloblastoma with available molecular data were identified during the study period with male to female ratio of 1.5:1 (42M:27F). Twelve patients (17.4%) belonged to SHH, 10 (14.5%) Wnt, 19 (27.5%) Group 3 and 15 (21.7%) Group 4; 13 (18.8%) were non-specified Group 3 or 4. A total of 18 (26%) patients had evidence of leptomeningeal disease at presentation (20% of Wnt, 42% of Group 3, 33% of group 4, 23% of group 3/4, and 0% of SHH). Fifteen patients (22%) underwent post-operative ventriculoperitoneal (VP) shunt insertion. No patient in the Wnt group required ventriculoperitoneal (VP) shunt post-operatively in this cohort. Need for shunt was associated with pre-operative hydrocephalus, leptomeningeal disease, with molecular group 3 or 4 demonstrating higher rate of leptomeningeal disease, and pre-operative hydrocephalus. Age, extent of resection and pre-operative EVD were not associated with need for shunt in this cohort. Regression analysis identified only pre-operative hydrocephalus and leptomeningeal disease as independent predictors of need for shunt post-resection in this cohort. Conclusion All patients requiring permanent post-operative VP shunt belonged to non-Wnt groups, particularly group 3 and 4. Although medullob
ISSN:0256-7040
1433-0350
DOI:10.1007/s00381-023-05853-z