Validating the therapeutic efficacy of preoperative endoscopic third ventriculostomy in the management of patients with posterior fossa tumors by monitoring changes in intracranial pressure

It is paramount to monitor and regulate intracranial pressure (ICP) in patients diagnosed with posterior fossa tumors (PFT) prior to surgical intervention. This study aims to find out optimal therapeutic management in patients with hydrocephalus induced by PFT through evaluating the changes in ICP following endoscopic third ventriculostomy (ETV). This study included 18 fully conscious patients with obstructive hydrocephalus due to PFT. They underwent ETV surgery at Rasoul Akram Hospital between 2020 and 2023. Intracranial pressure was monitored and recorded hourly after ETV and continuous after PFT resection. The mean age of the patients was 20.94 years, with 55.6 % being male. Astrocytoma (38.9 %) and medulloblastoma (22.2 %) were the most common pathologies. The mean time interval between undergoing ETV and tumor resection was 4 days. Analysis of ICP patterns in 4-hour timeframes revealed a decreasing pattern in the early hours after ETV. The mean ICP decreased from 18.44 mmHg at 4 h after ETV to 14.11 mmHg at 36 h after ETV. After 36 h, there was a fluctuation in the ICP pattern. A significant reduction in ICP was also observed after tumor resection (P > 0.05). ETV is an effective technique for reducing intracranial pressure in patients with hydrocephalus due to PFTs. Furthermore, the best time for tumor resection appears to be within the first 36–48 h after ETV, when ICP reaches its lowest point.