Predictive factors in the Management of Hydrocephalus and Cerebrospinal Fluid Related Complications in Pediatric Choroid Plexus Tumors: A Single-Center Experience

Objective: The intimate relation between hydrocephalus and pediatric Choroid Plexus Tumors (CPTs) should attain special care owing to the high incidence of permanent Cerebrospinal Fluid (CSF) diversion in those patients. To our knowledge, this is the first study that analyzes predictive factors linked to permanent CSF diversion in children with CPTs. Methods: We included all cases who were treated between January 2012 and December 2022 upfront in our institute with a follow-up from 12 to 106 months. Children in whom ventriculoperitoneal shunts were placed before tumor excision were excluded. Demographic data, radiological findings, operative details, and postoperative management of hydrocephalus, and CSF-related complications were reviewed. Results: A total of 80 children with CPTs were included in our study, 58 children (72.5%) needed permanent CSF diversion methods. CSF permeation in FLAIR/T2 sequence ( p- value 0.05), longer duration of external ventricular drainage ( p- value 0.032) and horn entrapment ( p- value 0.03) were related to permanent CSF diversion. Location of the tumor, maximum tumor diameter; consistency, preoperative Evan’s index; and amount of blood in ventricles were not statistically significant. We found that tumor pathology, parenchymal invasion and extent of resection were statistically significant factors in relation to postoperative entrapment (p-values = 0.016, 0.001, 0.042)). Conclusion: Hydrocephalus has an intimate relation with pediatric choroid plexus tumors. Placement of a shunt could be inevitable at the end in most of them. However, transependymal CSF permeation in preoperative imaging, duration of EVD placement and entrapment due to parenchymal invasion or high-grade disease are associated with higher rates of CSF diversion.