Aqueduct-fourth ventricle-cisterna magna shunting as a prophylactic procedure for postoperative hydrocephalus in selective fourth ventricular tumors: A retrospective study

Surgery for fourth ventricular tumors (FVT) is plagued by potential CSF blockage after the tumor removal due to a plethora of reasons. Thus, we explored the use of aqueduct-fourth ventricle-cisterna magna (AFVCM) shunting as prophylactic procedure for postoperative hydrocephalus after FVT resection. We retrospectively gathered the data of patients who underwent surgery of the fourth ventricle tumor between January 2019 and December 2021 at the Department of Neurosurgery in West China Hospital of Sichuan University. In all, a total of 96 selective cases were selected among 237 fourth ventricle tumor cases because of their superior tumor extension into the aqueduct. The patients were categorized into AFVCM shunting and no AFVCM shunting groups and risks factors for the development of postoperative hydrocephalus evaluated and their clinical outcomes were compared. In all 20 patients in the no AFVCM shunting group developed postoperative hydrocephalus out of the 96 patients included in the study. Univariate analysis revealed that AFVCM shunting (P = .0062) salvaged postoperative hydrocephalus. Multivariate analysis revealed that type of tumor (P = .017; OR = 1.076; 95% CI = 0.814-1.422), tumor size (P = .025; OR = 1.057; 95% CI = 0.516-2.165), residual tumor (P = .005; OR = 1.466; 95% CI = 0.833-2.581) were factors associated with postoperative hydrocephalus. However, AFVCM shunting (P = .029; OR = 5.47265E-13; 95% CI = 0.000-inf) salvaged postoperative hydrocephalus. AFVCM shunting may prevent postoperative hydrocephalus and reduce costs in patients with superior tumor extension into the aqueduct and failed total tumor resection.