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Purpose <p>Infratentorial brain metastases (BM), particularly those causing obstruction of the fourth ventricle, are associated with a significant risk of postoperative hydrocephalus. This complication remains poorly understood, especially regarding its predictors beyond mechanical obstruction. This study aims to identify clinical predictors of postoperative hydrocephalus in patients undergoing surgery for infratentorial BM.</p> Methods <p>We performed a single-center retrospective analysis of 235 adult patients surgically treated for infratentorial BM between 2009 and 2025. Patients with leptomeningeal disease were excluded. Pre- and postoperative hydrocephalus were defined based on imaging and clinical criteria. Logistic regression and multivariate modeling were used to evaluate predictors, including clinical presentation, treatment history, and imaging features.</p> Results <p>Postoperative hydrocephalus occurred in 18.45% of patients. Breast cancer patients exhibited the highest incidence (30.61%), significantly more than those with lung cancer (15.66%, p = 0.042). Preoperative hydrocephalus (p = 0.005), and prior chemotherapy (p = 0.001) or radiotherapy (p = 0.004) were significantly associated with postoperative hydrocephalus. Imaging variables, including tumor volume or proximity to the fourth ventricle, were not predictive. Multivariate regression confirmed preoperative hydrocephalus, and systemic treatment as independent risk factors.</p> Conclusion <p>Postoperative hydrocephalus in infratentorial BM is influenced not only by mechanical factors but also by preoperative clinical and therapeutic variables. Breast cancer patients, particularly those who received prior systemic or local therapy, are at higher risk. These findings suggest the need for individualized risk assessment and raise the question of whether prophylactic interventions could mitigate complications and treatment delays in high-risk cohorts.</p>

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Postoperative hydrocephalus in patients with infratentorial brain metastases may be influenced by preoperative treatment: a single-center cohort study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年6月23日

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  • Luisa Mona Kraus,
  • Maria Goldberg,
  • Eugen Ursu,
  • Kayra Demirbag,
  • Simon Paul Backhaus,
  • Ghaith Altawalbeh,
  • Denise Bernhardt,
  • Chiara Negwer,
  • Stephanie Combs,
  • Bernhard Meyer,
  • Arthur Wagner

摘要

Purpose

Infratentorial brain metastases (BM), particularly those causing obstruction of the fourth ventricle, are associated with a significant risk of postoperative hydrocephalus. This complication remains poorly understood, especially regarding its predictors beyond mechanical obstruction. This study aims to identify clinical predictors of postoperative hydrocephalus in patients undergoing surgery for infratentorial BM.

Methods

We performed a single-center retrospective analysis of 235 adult patients surgically treated for infratentorial BM between 2009 and 2025. Patients with leptomeningeal disease were excluded. Pre- and postoperative hydrocephalus were defined based on imaging and clinical criteria. Logistic regression and multivariate modeling were used to evaluate predictors, including clinical presentation, treatment history, and imaging features.

Results

Postoperative hydrocephalus occurred in 18.45% of patients. Breast cancer patients exhibited the highest incidence (30.61%), significantly more than those with lung cancer (15.66%, p = 0.042). Preoperative hydrocephalus (p = 0.005), and prior chemotherapy (p = 0.001) or radiotherapy (p = 0.004) were significantly associated with postoperative hydrocephalus. Imaging variables, including tumor volume or proximity to the fourth ventricle, were not predictive. Multivariate regression confirmed preoperative hydrocephalus, and systemic treatment as independent risk factors.

Conclusion

Postoperative hydrocephalus in infratentorial BM is influenced not only by mechanical factors but also by preoperative clinical and therapeutic variables. Breast cancer patients, particularly those who received prior systemic or local therapy, are at higher risk. These findings suggest the need for individualized risk assessment and raise the question of whether prophylactic interventions could mitigate complications and treatment delays in high-risk cohorts.