CLINICAL ARTICLE J Neurosurg 129:984–996, 2018 ABBREVIATIONS CDB/RM = Clinical Database/Resource Manager; ICH = intracranial hemorrhage; NPH = normal pressure hydrocephalus; VP = ventriculoperitoneal. SUBMITTED April 4, 2017. ACCEPTED June 19, 2017. INCLUDE WHEN CITING Published online December 22, 2017; DOI: 10.3171/2017.6.JNS17859. Outcomes following cerebrospinal fuid shunting in high-grade glioma patients Lorenzo Rinaldo, MD, PhD, Desmond Brown, MD, PhD, Giuseppe Lanzino, MD, and Ian F. Parney, MD, PhD Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota OBJECTIVE The clinical course of high-grade central nervous system gliomas is occasionally complicated by hydro- cephalus. The risks of shunt placement and clinical outcome following CSF diversion in this population are not well defned. METHODS The authors retrospectively reviewed the outcomes of patients with pathologically confrmed WHO grade III or IV gliomas with shunt-treated hydrocephalus at their institution. Outcomes of patients in this cohort were compared with those of patients who underwent shunt treatment for normal pressure hydrocephalus (NPH). Hospital-reported out- comes in a national database for malignant primary brain tumor patients undergoing a ventricular shunt procedure were also reviewed. RESULTS Forty-one patients undergoing CSF shunting between 2001 and 2016 at the authors’ institution were identi- fed. Noncommunicating and communicating hydrocephalus occurred at similar rates (51.2% vs 48.8%). Symptomatic improvement after shunting was observed in 75.0% of patients. A major complication occurred in 17.1% of cases, with 2 patients suffering an intracranial hemorrhage. Prior administration of bevacizumab was signifcantly associated with the incidence of hemorrhage (p = 0.026). Three patients (7.3%) died during admission, and 8 (19.5%) died within 30 days of shunt placement. The presence of ependymal or leptomeningeal enhancement was more common in patients who died within 30 days (75.0% vs 11.1%, p = 0.001). Six patients (18.1%) required readmission to the hospital within 30 days of discharge. Revision surgery was necessary in 7 patients (17.1%). The median time from shunt placement to death was 150.5 days. In comparison with patients with NPH, shunt-treated high-grade glioma patients had increased in-hospital (7.3% vs 0.5%, p = 0.008) and 30-day (19.5% vs 0.8%, p < 0.001) mortality but no difference in the incidence of revision surgery (17.1% vs 17.5%, p = 0.947). Similarly, in the national Vizient Clinical Database Resource Manager, shunt-treated patients with malignant primary brain tumors had an increased length of stay (6.9 vs 3.5 days, p < 0.001), direct cost of admission ($15,755.80 vs $9871.50, p < 0.001), and 30-day readmission rates (20.6% vs 2.4%, p < 0.001) compared with patients without brain tumors who received a shunt for NPH. CONCLUSIONS Shunting can be an effective treatment for the symptoms of hydrocephalus in patients with high-grade gliomas. However, the authors’ results suggest that this procedure carries a signifcant risk of complications in this pa- tient population. https://thejns.org/doi/abs/10.3171/2017.6.JNS17859 KEY WORDS bevacizumab; communicating hydrocephalus; malignant gliomas; mortality; obstructive hydrocephalus; reoperation; ventriculoperitoneal shunt; oncology H ydrocepHalus, either communicating secondary to impaired CSF resorption or noncommunicat- ing due to obstructive pathology, is a known com- plication of primary central nervous system high-grade gliomas in the primary central nervous system. 1,3,12 CSF diversion in the form of ventricular shunting is an ef- fective therapy for the symptoms of hydrocephalus and may also extend survival in this patient population. 1 In- formation on clinical outcomes after shunt treatment in patients with malignant gliomas is limited to small case series, 1,3,6,12,15 and the risk of complications after shunting, particularly the risk of subsequent revision surgery, is not well-defned in this clinical context. The standard of care for high-grade gliomas currently includes both adjuvant J Neurosurg Volume 129 • October 2018 984 ©AANS 2018, except where prohibited by US copyright law Unauthenticated | Downloaded 12/09/21 12:10 AM UTC