Introduction: Communicating hydrocephalus is a rare complication in patients treated for glioblastoma (GBM). The etiology of this disruption in flow of cerebrospinal fluid is often unknown. We sought to analyze presenting clinical characteristics and outcomes in glioblastoma patients who underwent venticuloperitoneal shunt (VPS) for communicating hydrocephalus.
Methods: We retrospectively reviewed clinical and radiological data from 33 GBM patients who underwent VPS placement for communicating hydrocephalus at our institution between 1997 and 2012. Diagnosis-date matched GBM patients who did not develop hydrocephalus served as controls. Preoperative clinical characteristics, including treatment and functional status were analyzed, as were postoperative outcomes.
Results: 33 of 342 GBM patients developed clinical and radiographic evidence of communicating hydrocephalus and underwent VPS placement. Patient characteristics are summarized in Table 1. Shunting consistently resulted in clinical benefit with improved postoperative Karnofsky Performance Scores (KPS) (p = 0.0001). 19/33 (58%) shunted patients presented with enlarging ventricles which predicted postoperative KPS improvement (p= 0.037). 15% of patients had ventricular entry at initial craniotomy compared to 6% of controls. Median overall survival (OS) was 5.5 months after shunting. Total resection at diagnosis and completion of adjuvant chemotherapy or radiation were correlated to greater OS after shunt placement (p=0.011, p = 0.001, p = 0.013). Time between first recurrence and VPS was inversely correlated to OS (p = 0.03). Other factors such age, initial tumor volume and the number of prior resections were not correlated to OS or improvement in KPS.
Conclusions: VPS improves performance status in GBM patients with non-obstructive hydrocephalus. While shunts are sometimes placed because of symptoms alone, patients with enlarging ventricles had increased likelihood of improvement. Our results suggest that there is benefit to VPS in GBM patients with communicating hydrocephalus regardless of age, time after recurrence, and number of prior resections.
Patient Care: Our data on clinical characteristics predictive of clinical improvement and outcome as well as the value of VPS in GBM patients with communicating hydrocephalus offer a better insight into the nature of the condition, potential predisposing factors, and a beneficial treatment. This study will improve patient care through identifying the utility of VPS as an essential element in the management of glioblastoma patients exhibiting communicating hydrocephalus and would assist surgeons in improving targeted evaluation of these patients leading to maximum outcome.
Learning Objectives: By the conclusion of this session, participants should be able to:
1) Understand communicating-hydrocephalus as a complication in GBM patients, 2) Identify preoperative characteristics that impact improvement in performance status and outcome, and 3) Recognize the benefit of VPS in GBM patients with clinical deterioration suggestive of communicating hydrocephalus.