F. Nigim1, J. Critchlow1, E. Kasper1 1Beth Israel Deaconess Medical Center,Department Of Surgery,Brookline, MA, USA
Introduction:
About 1-5% of patients with cerebral metastasis suffer from hydrocephalus, and so do about 40% of patients with primary brain tumors. These patients often carry a poor prognosis. The aim of the present study is to reassess the validity of VPS placement with the assistance of the general surgeon in the abdominal part in oncological patients.
Methods:
A total of 59 patients underwent first time VPS placement at BIDMC between 2004 and 2012; 40 had hydrocephalus from brain metastasis and 19 from primary tumors. Analyzed independent variables included demographics, BMI, PMH, clinical presentation, indication for surgery, Karnofsky performance status (KPS) score, and surgical technique; dependent variables were post-operative symptoms and occurrence, cause, and time of shunt failures. Outcomes were analyzed via T-test and Kaplan-Meier estimates for shunt survival.
Results:
Mean age was 57.2 years; and mean operative time was 50.4 minutes. Symptomatic palliation was achieved in 93%; patients with severe symptoms (e.g. debilitating headaches and nausea and vomiting) did benefit significantly from VPS placement. Mean follow-up time was 6.3 months, complications occurred in only 6.7% (n=4) patients during follow up; with 2 wound infections treated with antibiotics, and 2 shunt obstructions requiring revision. Initial KPS and 3-month KPS were 65 ± 16.4 and 75 ± 16.0, respectively. We started with 59 patients, 16 (27.1%) patients were alive at 6-month and 10 (16.9%) patients were alive at 1-year, in all survived patients the shunt was functioning.
Conclusion:
VPS remains a valid option for cancer patients with low KPS and improves the quality of life in those patients, even in the setting of previous infection, hemorrhage, or leptomeningeal disease since shunt patency outlasts the overall survival of nearly all patients.