Editor’s Choice: Ventriculoperitoneal Shunting for Glioblastoma: Risk Factors, Indications, and Efficacy

Glioblastoma, the most common adult primary brain tumor, is marked by uniformly poor prognosis despite current standard of care, including surgical resection, radiation therapy, and temozolomide chemotherapy. Overall survival (OS) from diagnosis has gradually increased over the last decade to 22 months1 from approximately 15 months.2 As glioblastoma patients continue to survive longer and undergo more craniotomies, a larger proportion will likely exhibit long-term sequelae of their therapies or progressive disease such as hydrocephalus.

Hydrocephalus is the abnormal accumulation of cerebrospinal fluid (CSF) within the ventricular system and can be categorized into obstructive hydrocephalus (OH; secondary to a physical blockage of CSF drainage) or communicating hydrocephalus (CH; secondary to increased production or decreased absorption of CSF) variants. Glioblastoma-associated OH can be due to mass effect or surrounding edema from the tumor itself (typically in the posterior fossa, brainstem, or thalamic region) and can present at any point in the disease course. Glioblastoma-associated CH may reflect accumulation of scarring in the ventricular CSF absorptive system after radiation and multiple craniotomies, which would lead to this phenomenon occurring in recurrent or posttreated patients.3,4 In either variant, patients present with some combination of symptoms, typically associated with increased intracranial pressure, including headache, nausea/vomiting, motor disturbances, cognitive decline, or gait instability.5 On magnetic resonance imaging, patients will typically have ventriculomegaly, either throughout the ventricular system (communicating) or proximal to the CSF outflow blockage (obstructive).

From Ventriculoperitoneal Shunting for Glioblastoma: Risk Factors, Indications, and Efficacy by Brandyn A. Castro, MD, Brandon S. Imber, MD, Rebecca Chen, BS, Michael W. McDermott, MD, Manish K. Aghi, MD, PhD