Establishing the indications of cerebrospinal fluid diversion following pediatric primary intracranial tumor resection: a systematic review and meta-analysis

Abstract Background While cerebrospinal fluid (CSF) diversion procedures following primary intracranial tumors resection are commonly employed, precise indications in pediatric population remain unclear. This study aims to establish evidence-based indicators for CSF diversion in this population. Methods Systematic searches of ScienceDirect, Medline, and Cochrane databases identified longitudinal studies up to April 2024. Analysis compared risk factors for CSF diversion based on preoperative parameters, surgical technique, tumor characteristics, and postoperative parameters. Subgroup analysis considered ethnicity, tumor location, and presenting hydrocephalus. Results Our meta-analysis of 7 cohort studies included 844 children (mean age 7.30 ± 1.05 years) with a mean tumor volume of 27.90 ± 14.56 cm 3 . Preoperative hydrocephalus (OR 2.91, 95% CI 1.46–5.82, p < 0.001) and periventricular lucency (PVL) (OR 3.60, 95% CI 1.64–7.92, p < 0.001) were strongly associated with CSF diversion, as were medulloblastoma (OR 2.36, 95% CI 1.52–3.65, p < 0.001) and postoperative intraventricular blood (OR 5.19, 95% CI 3.00–8.98, p < 0.001). Neither gross total nor subtotal resection showed significance for CSF diversion. Ventricle infiltration (OR 2.79, 95% CI 1.76–4.42, p < 0.001) and large tumor volume (OR 2.23, 95% CI 1.01–4.92, p = 0.05) were also identified as risk factors, while midline tumor was not. Subgroup analysis showed postoperative infection increased CSF diversion risk in children without initial hydrocephalus (OR 5.18, 95% CI 2.05–13.14, p = 0.04). Conclusion Preoperative hydrocephalus, preoperative PVL, medulloblastoma, ventricle infiltration, large tumor volume, and postoperative intraventricular blood increase the likelihood of CSF diversion following pediatric primary tumor resection.