Symptomatic communicating hydrocephalus in a contemporary cohort of high grade glioma patients

Abstract

Introduction: High grade glioma (HGG) treatment has seen a paradigm shift with intensified regimes, but hospitalisation burden is partially attributed to side effects of therapy. Symptomatic communicating hydrocephalus (HC) is a potential complication. Aim of this study was to investigate its incidence, risk factors and treatment in a contemporary cohort.

Methods: We performed a retrospective review of HGG patients. Patients with symptomatic communicating HC were identified and demographic, tumour and treatment variables extracted from hospital notes. Descriptive statistics were performed and odds ratios (OR) with 95% confidence intervals (CI) calculated.

Results: From a cohort of 278 eligible HGG patients, 8 (3%) were diagnosed with symptomatic communicating HC. In the subgroup of patients with intraoperative opening of the ventricular system during previous surgery (N = 66), hydrocephalus developed in 10.6% of cases (N = 7). Symptoms were lethargy (N = 5), headache (N = 3), confusion (N = 3), gait disturbance (N = 3) and urinary incontinence (N = 1); three patients presented resembling normal pressure hydrocephalus. A higher rate of intraoperative opening of the ventricles was found in the HC group (p = .0002); all other variables were equally distributed. The increased odds for developing HC for patients with intraoperative opening of the ventricles reached statistical significance (OR = 25.0339, 95% CI = 3.0196–207.5449, p = .0028), whereas previous radiotherapy only increased odds by tendency. Hydrocephalic patients were treated with ventriculoperitoneal shunts and all but one patient improved. One patient had a complication attributed to the shunt procedure The median overall survival after shunting was 4 months.

Conclusions: Symptomatic communicating hydrocephalus occurred in 3% of HGG patients and in 10.6% in the subgroup with previous intraoperative opening of the ventricles. Treatment with a ventriculoperitoneal shunt is effective and has a low complication rate.

Keywords:

• Glioma
• glioblastoma
• hydrocephalus
• cerebrospinal fluid shunt

Acknowledgements

Parts of this work were presented at the 65th Annual Meeting of the German Society of Neurosurgery (DGNC), Dresden, Germany, May 11-14, 2014.

Dislcosure statement

The authors report no conflict of interest.