SURG-25. Choroid plexus cauterization prevents postoperative hydrocephalus and preserves functional outcomes after glioblastoma resection with ventricular breach

Abstract Glioblastoma is known to infiltrate along white matter tracts to peri-ventricular regions such as the subventricular zone. Surgical attempts at supramaximal resection often lead to ventricular entry, which is associated with a 7.8-fold increased risk of postoperative hydrocephalus. While choroid plexus cauterization (CPC) reduces rates of hydrocephalus in pediatric hemispherectomy, its effectiveness in glioblastoma resection has not been studied. A single-institution retrospective review of 863 craniotomies for glioblastoma was conducted with the following inclusion criteria: age >18, pathologically-confirmed glioblastoma, intraoperative ventricular breach, and postoperative follow-up >90d. CPC was prospectively performed in 18 patients. 261 patients were included in this study, and 67 (25.7%) developed postoperative hydrocephalus. There was no difference in overall survival (mean 12.5 vs 12.8 months, p=0.500); however, hydrocephalus patients had more hospital readmissions (2.3 vs 0.7 two-year postoperative readmissions, p=<0.00001), longer hospital stays (mean 10.0 vs 6.5 days, p=0.0461), and greater declines in Karnofsky Performance Status (KPS) (-19.8 vs -6.9, p=<0.00001) compared to non-hydrocephalus patients. Of the 18 patients who underwent prospective CPC, there were no postoperative complications and no patients developed hydrocephalus (0% vs 25.7%, p=0.0139) compared to non-CPC patients. There was no survival benefit for CPC patients (mean 9.8 vs 12.5 months, p=0.592), but CPC patients had fewer two-year postoperative readmissions (0.8 vs 2.3, p=0.00079) and better preservation of functional status (KPS –7.8 vs –19.8, p=0.0065) compared to non-CPC hydrocephalus patients. With ventricular breach becoming increasingly common during supramaximal glioblastoma resection, our findings highlight the significant burden of postoperative hydrocephalus – increased readmissions, prolonged hospital stays, and greater functional decline. These outcomes underscore the need for effective hydrocephalus prevention strategies during glioblastoma resection. Our data demonstrates that choroid plexus cauterization is a safe and effective intervention to reduce the incidence of postoperative hydrocephalus and is associated with fewer readmissions and better preservation of functional status.