Abstract：
Hydrocephalus is commonly associated with paediatric posterior fossa tumours and their resection. This is commonly managed by ventriculoperitoneal shunt insertion, which is associated with a lifelong risk of malfunction, necessitating revisional surgery. Few opportunities ever arise for the patient to be free of the shunt and this risk. We describe three patients shunted for tumour-related hydrocephalus who subsequently developed spontaneous shunt independence. We discuss this in the context of the literature.
A single-centre retrospective case series analysis was performed using a departmental database. Case notes were retrieved from a local electronic records database, and images were reviewed using national Picture Archiving and Communication Systems.
Over a 10-year period, 28 patients underwent ventriculoperitoneal shunt insertion for tumour-related hydrocephalus. Of these, 3 patients (10.7%) went on to have their shunts successfully removed. Age at presentation varied from 1 to 16 years. In all cases, the patient required shunt externalization due to shunt or intra-abdominal infection. This was used as an opportunity to challenge the need for ongoing cerebrospinal fluid (CSF) diversion. In one case, this occurred only several months after a shunt blockage with intracranial pressure monitoring that proved her shunt dependence. All three patients tolerated this challenge, their shunt systems were removed without complication, and they remain free of hydrocephalus at last follow-up.
These cases reflect our poor understanding of the heterogenous physiology of patients with shunted hydrocephalus and underline the importance of challenging the need for CSF diversion at any appropriate opportunity.
A single-centre retrospective case series analysis was performed using a departmental database. Case notes were retrieved from a local electronic records database, and images were reviewed using national Picture Archiving and Communication Systems.
Over a 10-year period, 28 patients underwent ventriculoperitoneal shunt insertion for tumour-related hydrocephalus. Of these, 3 patients (10.7%) went on to have their shunts successfully removed. Age at presentation varied from 1 to 16 years. In all cases, the patient required shunt externalization due to shunt or intra-abdominal infection. This was used as an opportunity to challenge the need for ongoing cerebrospinal fluid (CSF) diversion. In one case, this occurred only several months after a shunt blockage with intracranial pressure monitoring that proved her shunt dependence. All three patients tolerated this challenge, their shunt systems were removed without complication, and they remain free of hydrocephalus at last follow-up.
These cases reflect our poor understanding of the heterogenous physiology of patients with shunted hydrocephalus and underline the importance of challenging the need for CSF diversion at any appropriate opportunity.
摘要：
目的：脑积水通常与小儿后颅窝肿瘤及其切除有关。这通常通过脑室-腹腔分流术治疗,这与终生的故障风险有关，需要进行修正手术。很少有机会使患者摆脱分流和这种风险。我们描述了三名因肿瘤相关的脑积水而分流的患者，这些患者随后发生了自发分流独立性。我们在文献的背景下讨论这一点。
方法：使用部门数据库进行单中心回顾性病例系列分析。案例记录是从当地电子记录数据库中检索的，和图像使用国家图片存档和通信系统进行审查。
结果：在10年内，28例患者因肿瘤相关的脑积水接受了脑室腹腔分流术。其中,3名患者（10.7％）继续成功切除了分流。演讲年龄从1岁到16岁不等。在所有情况下,由于分流术或腹腔感染,患者需要分流术.这被用作挑战持续脑脊液（CSF）转移需求的机会。在一个案例中,这种情况仅发生在颅内压监测的分流阻塞后几个月,这证明了她的分流依赖性.所有三名患者都能忍受这种挑战，他们的分流系统被移除，没有并发症，在最后的随访中，他们仍然没有脑积水。
结论：这些病例反映了我们对分流性脑积水患者异质性生理的认识不足，并强调了在任何适当时机挑战脑脊液转流需求的重要性。
方法：使用部门数据库进行单中心回顾性病例系列分析。案例记录是从当地电子记录数据库中检索的，和图像使用国家图片存档和通信系统进行审查。
结果：在10年内，28例患者因肿瘤相关的脑积水接受了脑室腹腔分流术。其中,3名患者（10.7％）继续成功切除了分流。演讲年龄从1岁到16岁不等。在所有情况下,由于分流术或腹腔感染,患者需要分流术.这被用作挑战持续脑脊液（CSF）转移需求的机会。在一个案例中,这种情况仅发生在颅内压监测的分流阻塞后几个月,这证明了她的分流依赖性.所有三名患者都能忍受这种挑战，他们的分流系统被移除，没有并发症，在最后的随访中，他们仍然没有脑积水。
结论：这些病例反映了我们对分流性脑积水患者异质性生理的认识不足，并强调了在任何适当时机挑战脑脊液转流需求的重要性。
