Posterior fossa metastasis-associated obstructive hydrocephalus in adult patients: literature review and practical considerations from the Neuro-Oncology Club of the French Society of Neurosurgery.

BACKGROUND: There is no consensus concerning the management of adult posterior fossa metastasis-associated obstructive hydrocephalus patients, especially regarding surgical procedures. OBJECTIVES: Literature review to assess the surgical strategy in the management of metastatic brain tumor patients. DATA SOURCES: Literature search conducted on PubMed in November 2017 to identify all studies concerning brain metastases and obstructive hydrocephalus in the English language. STUDY ELIGIBILITY CRITERIA: All studies between December 1953 and November 2017, except case reports and paediatric studies, which were about posterior fossa metastasis-associated obstructive hydrocephalus in adult patients. METHODS: Eligible studies were classified by level of evidence. We assessed epidemiology, clinical and imaging findings, neurosurgical management and prognosis of posterior fossa metastasis-associated obstructive hydrocephalus adult patients. We suggest some practical considerations and a management decision-tree on the behalf of the Neuro-oncology Club of the French Society of Neurosurgery with evidence-based analysis. RESULTS: Direct surgical resection could be considered for asymptomatic obstructive hydrocephalus patients and endoscopic third ventriculostomy seems to be a reasonable procedure for symptomatic obstructive hydrocephalus patients. Ventriculoperitoneal or atrial shunt seems to be a valid alternative when patients have a history of central nervous system infection or ventricular haemorrhage, leptomeningeal carcinomatosis, or unfavorable anatomy to perform an endoscopic third ventriculostomy. LIMITATIONS: No formal recommendations can be made due to the low level of scientific evidence. CONCLUSIONS: The Neuro-oncology Club of the French Society of Neurosurgery suggests a prospective assessment of these neurosurgical procedures in order to compare their respective safeties and efficacies.