Long-term Outcome of Cerebrospinal Fluid Diversion in Patients with Intracranial Germinoma at Ramathibodi Hospital

Overview

Journal Langenbecks Arch Surg

Specialty General Surgery

Date 2025 Feb 14

PMID 39953196

Authors

Wasawat Muninthorn

Wattana Mahattanakul

Siriwut Pokanan

Atthaporn Boongird

Tanaporn Jaroenngarmsamer

Ake Hansasuta

Affiliations

Soon will be listed here.

Abstract

Introduction: Intracranial germinoma has a favorable prognosis with modern therapies, but the long-term outcome of cerebrospinal fluid (CSF) diversion for its associated hydrocephalus has been rarely focused on.

Purpose: To evaluate the long-term success of CSF diversion methods-endoscopic third ventriculostomy (ETV) versus ventriculoperitoneal (VP) shunt-in intracranial germinoma patients.

Methods: Only pure intracranial germinomas with obstructive hydrocephalus and a minimum follow-up duration of 24 months were retrospectively reviewed. Their demographics, as well as pre-and postoperative data, were recorded. Patients were stratified into the ETV and the non-ETV groups and subsequently compared to determine the longevity and morbidity related to the procedures. Factors associated with the failure of CSF diversion were examined.

Results: From 1993 to 2022, eighty-three pathologically confirmed intracranial germinomas were identified. Excluding four cases of mixed pathology, eight with incomplete data, and two with insufficient follow-up, we enrolled 69 eligible patients for analysis. Among them, forty-three cases with obstructive hydrocephalus were classified into the ETV (n = 22) and non-ETV (n = 21) groups. No intraoperative or immediate postoperative complications occurred. With a median follow-up of 101 months (IQR 77.75-139.75), the ETV group had no failures. In the non-ETV cohort (median follow-up 144 months (IQR 97-210)), two VP shunt cases (9.5%) required revision due to blockage, and two patients (9.5%) experienced transient over-drainage. These 4 patients were without long-term difficulty despite short-term cumbersome events. No significant factors predicting CSF diversion failure were identified. To date, all 43 patients are alive without metastases, maintaining a good quality of life.

Conclusion: This study highlights ETV as a preferred CSF diversion method in pure intracranial germinoma, achieving 100% success without morbidity. Apart from simultaneous biopsy, avoiding a separate operation, this approach eliminates shunt-related complications, ensuring long-term quality of life in patients with extraordinary prognoses from modern chemo- and radiotherapy.

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