2026 Poster Presentations
P169: PROPOSAL FOR A SYSTEMATIC APPROACH TO THE MANAGEMENT OF HYDROCEPHALUS SECONDARY TO INTRAVENTRICULAR TUMORS
Alex Roman, Msc, MD1; Rudolfh Batista Arend, MS2; Daniel Felipe Savaris, MS2; Samuel Luís Scaravonatto Baldo Cunha, MS3; Bruno Zilli Peroni2; Emanuel Abrantes Barros, MS4; Filipe Virgilio Ribeiro5; Guilherme Gago, MD6; 1Institute of Neurosurgery and Spine Surgery (INCC), Passo Fundo, Brazil; 2Federal University of Fronteira Sul (UFFS), Passo Fundo, RS, Brazil; 3ATITUS Education, Faculty of Medicine. Passo Fundo, Rio Grande do Sul, Brazil; 4Petrópolis School of Medicine. Petrópolis, Rio de Janeiro, Brazil; 5Barão de Mauá University Center, Faculty of Medicine. Ribeirão Preto, SP, Brazil; 6Université Laval, Quebec, Canada
Objective: To propose a flowchart outlining a systematic approach for the management of hydrocephalus secondary to intraventricular tumors.
Method: We conducted a narrative review by searching PubMed, Embase, Scopus, and Web of Science up to April 2025, analyzing studies that evaluated the relationship between intraventricular tumors and hydrocephalus. We included studies reporting any type of intraventricular tumor that addressed preoperative hydrocephalus and its management, postoperative hydrocephalus and its management, as well as preventive strategies for the occurrence of hydrocephalus. Studies focusing on other pathologies or not addressing hydrocephalus were excluded. We considered both primary studies and literature reviews, while conference abstracts and preclinical studies were excluded.
Result: For patients presenting with hydrocephalus at diagnosis, CSF diversion is indicated, which may be temporary – such as an external ventricular drain (EVD) – or permanent, including ventriculoperitoneal shunt (VPS), ventriculoatrial shunt (VAS), endoscopic third ventriculostomy (ETV), or Ommaya reservoir. In patients without preoperative hydrocephalus, risk stratification is essential, guided by 'warning signs' such as clinical severity – particularly symptoms of intracranial hypertension (ICH) – younger age (< 3 years), tumor type (e.g., ependymoma, medulloblastoma, choroid plexus papilloma) and location (e.g., midline, posterior fossa), and intraoperative factors like incomplete resection, brain swelling, or intraventricular hemorrhage. High-risk patients may benefit from preventive CSF diversion, with decision-making focused on choosing between temporary strategies, such as EVD, and definitive procedures, including VPS, VAS, ETV, or Ommaya reservoir. In routine practice, temporary diversion should be preferred, whereas definitive approaches should be reserved for patients with permanent intracranial hypertension, given the inherent risks associated with each permanent option. In low-risk patients, tumor resection alone often resolves hydrocephalus by eliminating the obstruction, thereby avoiding the need for prior diversion procedures and the risks of additional interventions. In such cases, strict postoperative monitoring is mandatory, and follow-up neuroimaging – preferably magnetic resonance imaging (MRI) – should be performed. This systematic approach is dynamic and adaptable, allowing adjustments according to findings across different stages of treatment, from initial assessment to the postoperative period.
Conclusion: By integrating multiple risk factors, the proposed flowchart aims to optimize patient outcomes through a personalized approach to hydrocephalus management. This strategy balances the need for timely intervention with the potential risks associated with each procedure, supporting more rational and evidence-based decision-making. Furthermore, it provides a structured framework that can guide clinicians across different stages of care, from diagnosis to the postoperative period, while also highlighting patients who may benefit from preventive measures.
Figure 1. Proposal for a Systematic Approach to the Management of Hydrocephalus Secondary to Intraventricular Tumors.
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Abbreviations: CSF: cerebrospinal fluid; ETV: endoscopic third ventriculostomy; EVD: external ventricular drain; VAS: ventriculoatrial shunt; VPS: ventriculoperitoneal shunt.