{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,4]],"date-time":"2026-04-04T22:54:44Z","timestamp":1775343284054,"version":"3.50.1"},"reference-count":46,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,2,9]],"date-time":"2022-02-09T00:00:00Z","timestamp":1644364800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oncol."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Glioblastoma is the most common and the most challenging to treat adult primary central nervous system tumor. Although modern management strategies modestly improved the overall survival, the prognosis remains dismal associated with poor life quality and the clinical course often dotted by treatment side effects and cognitive decline. Functional deterioration might be caused by obstructive or communicating hydrocephalus but due to poor overall prognosis surgical treatment options are often limited and its optimal management strategies remain elusive. We aimed to investigate risk factors, treatment options and outcomes for tumor-associated hydrocephalus in a contemporary 10 years cohort of glioblastoma patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We reviewed electronic health records of 1800 glioblastoma patients operated at the Department of Neurosurgery, Medical Center \u2013 University of Freiburg from 2009 to 2019. Demographics, clinical characteristics and radiological features were analyzed. Univariate analysis for nominal variables was performed either by Fisher\u2019s exact test or Chi-square test, as appropriate.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We identified 39 glioblastoma patients with symptomatic communicating hydrocephalus treated by ventricular shunting (incidence 2.1%). Opening of the ventricular system during a previous tumor resection was associated with symptomatic hydrocephalus (p&amp;lt;0.05). There was also a trend toward location (frontal and temporal) and larger tumor volume. Number of craniotomies before shunting was not considered as a risk factor. Shunting improved hydrocephalus symptoms in 95% of the patients and Karnofsky Performance Score (KPS) could be restored after shunting. Of note, 75% of the patients had a post-shunting oncological treatment such as radiotherapy or chemotherapy, most prevalently chemotherapy. Infection (7.7%) and over- or under drainage (17.9%) were the most common complications requiring shunt revision in ten patients (25.6%), No peritoneal metastasis was found. The median overall survival (OS) was 385 days and the median post shunting survival was 135 days.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Ventricular system opening was identified as a risk factor for communicating hydrocephalus in glioblastoma patients. Although glioblastoma treatment remains challenging, shunting improved hydrocephalus-related functional status and may be considered even in a palliative setting for symptom relief.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fonc.2022.796105","type":"journal-article","created":{"date-parts":[[2022,2,9]],"date-time":"2022-02-09T14:17:53Z","timestamp":1644416273000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":14,"title":["Hydrocephalus Shunting in Supratentorial Glioblastoma: Functional Outcomes and Management"],"prefix":"10.3389","volume":"12","author":[{"given":"Amir","family":"El Rahal","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Debora","family":"Cipriani","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christian","family":"Fung","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marc","family":"Hohenhaus","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lukas","family":"Sveikata","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jakob","family":"Straehle","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mukesch Johannes","family":"Shah","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Henrik Dieter","family":"Heiland","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J\u00fcrgen","family":"Beck","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Oliver","family":"Schnell","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2022,2,9]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"IV1","DOI":"10.1093\/neuonc\/noaa200","article-title":"CBTRUS Statistical Report: Primary Brain and Other Central Nervous System Tumors Diagnosed in the United States in 2013-2017","volume":"22","author":"Cioffi","year":"2020","journal-title":"Neuro Oncol"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa043330","article-title":"Radiotherapy Plus Concomitant and Adjuvant Temozolomide for Glioblastoma","volume":"352","author":"Stupp","year":"2005","journal-title":"N Engl J Med"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1097\/PPO.0b013e318243f6c9","article-title":"Individualized Targeted Therapy for Glioblastoma: Fact or Fiction","volume":"18","author":"Weller","year":"2012","journal-title":"Cancer J"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejca.2014.05.019","article-title":"Changing Incidence and Improved Survival of Gliomas","volume":"50","author":"Ho","year":"2014","journal-title":"Eur J Cancer"},{"key":"B5","doi-asserted-by":"publisher","first-page":"ii1","DOI":"10.1093\/neuonc\/not151","article-title":"CBTRUS Statistical Report: Primary Brain and Central Nervous System Tumors Diagnosed in the United States in 2006-2010","volume":"15","author":"Ostrom","year":"2013","journal-title":"Neuro Oncol"},{"key":"B6","doi-asserted-by":"publisher","first-page":"iv1","DOI":"10.1093\/neuonc\/nov189","article-title":"CBTRUS Statistical Report: Primary Brain and Central Nervous System Tumors Diagnosed in the United States in 2008-2012","volume":"17","author":"Ostrom","year":"2015","journal-title":"Neuro Oncol"},{"key":"B7","doi-asserted-by":"crossref","DOI":"10.15586\/codon.glioblastoma.2017.ch8","article-title":"Epidemiology and Outcome of Glioblastoma","volume-title":"Glioblastoma [Internet]","author":"Tamimi","year":"2017"},{"key":"B8","doi-asserted-by":"publisher","first-page":"494","DOI":"10.1038\/ncpneuro0289","article-title":"Epidemiology and Molecular Pathology of Glioma","volume":"2","author":"Schwartzbaum","year":"2006","journal-title":"Nat Clin Pract Neurol"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.3171\/2011.8.JNS11738","article-title":"Communicating Hydrocephalus Following Surgery and Adjuvant Radiochemotherapy for Glioblastoma: Clinical Article","volume":"115","author":"Montano","year":"2011","journal-title":"J Neurosurg"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1007\/s007010200030","article-title":"Delayed Hydrocephalus After Resection of Supratentorial Malignant Gliomas","volume":"144","author":"Marquardt","year":"2002","journal-title":"Acta Neurochir (Wien)"},{"key":"B11","doi-asserted-by":"publisher","first-page":"9","DOI":"10.1016\/S0303-8467(03)00060-X","article-title":"Postoperative Communicating Hydrocephalus in Patients With Supratentorial Malignant Glioma","volume":"106","author":"Inamasu","year":"2003","journal-title":"Clin Neurol Neurosurg"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1007\/s00701-007-1454-0","article-title":"The Value of Ventriculo-Peritoneal Shunting in Patients With Glioblastoma Multiforme and Ventriculomegaly","volume":"150","author":"Roth","year":"2008","journal-title":"Acta Neurochir (Wien)"},{"key":"B13","doi-asserted-by":"publisher","first-page":"27","DOI":"10.1016\/j.clineuro.2014.02.012","article-title":"Hydrocephalus After Resection and Adjuvant Radiochemotherapy in Patients With Glioblastoma","volume":"120","author":"Fischer","year":"2014","journal-title":"Clin Neurol Neurosurg"},{"key":"B14","doi-asserted-by":"publisher","first-page":"68","DOI":"10.1080\/02688697.2017.1380780","article-title":"Symptomatic Communicating Hydrocephalus in a Contemporary Cohort of High Grade Glioma Patients","volume":"32","author":"Beez","year":"2018","journal-title":"Br J Neurosurg"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.1016\/j.wneu.2017.07.034","article-title":"The Prognostic Impact of Ventricular Opening in Glioblastoma Surgery: A Retrospective Single Center Analysis","volume":"106","author":"Behling","year":"2017","journal-title":"World Neurosurg"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(07)61602-X","article-title":"The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: Guidelines for Reporting Observational Studies","volume":"370","author":"von Elm","year":"2007","journal-title":"Lancet"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.1007\/s00401-016-1545-1","article-title":"The 2016 World Health Organization Classification of Tumors of the Central Nervous System: A Summary","volume":"131","author":"Louis","year":"2016","journal-title":"Acta Neuropathol"},{"key":"B18","doi-asserted-by":"publisher","first-page":"818","DOI":"10.1186\/s12885-020-07290-6","article-title":"Characterization of Longitudinal Transformation of T2-Hyperintensity in Oligodendroglioma","volume":"20","author":"Heiland","year":"2020","journal-title":"BMC Cancer"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.1007\/s11060-018-03030-w","article-title":"Surgical Management of Lower-Grade Glioma in the Spotlight of the 2016 WHO Classification System","volume":"141","author":"Delev","year":"2019","journal-title":"J Neurooncol"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM196507152730301","article-title":"Symptomatic Occult Hydrocephalus With Normal Cerebrospinal-Fluid Pressure \u2014 A Treatable Syndrome","volume":"273","author":"Adams","year":"1965","journal-title":"N Engl J Med"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.1001\/archneurpsyc.1942.02290060069004","article-title":"An Encephalographic Ratio for Estimating Ventricular Enlargement and Cerebral Atrophy","volume":"47","author":"Evans","year":"1942","journal-title":"Arch Neurol Psychiatry"},{"key":"B22","doi-asserted-by":"publisher","first-page":"3","DOI":"10.3171\/2011.2.JNS10998","article-title":"An Extent of Resection Threshold for Newly Diagnosed Glioblastomas: Clinical Article","volume":"115","author":"Sanai","year":"2011","journal-title":"J Neurosurg"},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2009.26.3541","article-title":"Updated Response Assessment Criteria for High-Grade Gliomas: Response Assessment in Neuro-Oncology Working Group","volume":"28","author":"Wen","year":"2010","journal-title":"J Clin Oncol"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.3171\/jns.2001.95.2.0190","article-title":"A Multivariate Analysis of 416 Patients With Glioblastoma Multiforme: Prognosis, Extent of Resection, and Survival","volume":"95","author":"Lacroix","year":"2001","journal-title":"J Neurosurg"},{"key":"B25","doi-asserted-by":"publisher","DOI":"10.3171\/2010.4.JNS091340","article-title":"Factors Involved in Maintaining Prolonged Functional Independence Following Supratentorial Glioblastoma Resection: Clinical Article","volume":"114","author":"Chaichana","year":"2011","journal-title":"J Neurosurg"},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.1093\/neuonc\/not137","article-title":"Establishing Percent Resection and Residual Volume Thresholds Affecting Survival and Recurrence for Patients With Newly Diagnosed Intracranial Glioblastoma","volume":"16","author":"Chaichana","year":"2014","journal-title":"Neuro Oncol"},{"key":"B27","doi-asserted-by":"publisher","DOI":"10.1002\/acn3.17","article-title":"The Role of Ventriculoperitoneal Shunting in Patients With Supratentorial Glioma","volume":"1","author":"de la Fuente","year":"2014","journal-title":"Ann Clin Transl Neurol"},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.1007\/s10143-017-0869-1","article-title":"Risk Factors for New-Onset Shunt-Dependency After Craniotomies for Intracranial Tumors in Adult Patients","volume":"41","author":"Hosainey","year":"2018","journal-title":"Neurosurg Rev"},{"key":"B29","doi-asserted-by":"publisher","DOI":"10.3171\/2017.6.JNS17859","article-title":"Outcomes Following Cerebrospinal Fluid Shunting in High-Grade Glioma Patients","volume":"129","author":"Rinaldo","year":"2018","journal-title":"J Neurosurg"},{"key":"B30","doi-asserted-by":"publisher","DOI":"10.1227\/NEU.0000000000001263","article-title":"Ventriculoperitoneal Shunting for Glioblastoma: Risk Factors, Indications, and Efficacy","volume":"80","author":"Castro","year":"2017","journal-title":"Neurosurgery"},{"key":"B31","doi-asserted-by":"publisher","DOI":"10.1001\/archneur.55.5.705","article-title":"Hydrocephalus in Radiation Leukoencephalopathy: Results of Ventriculoperitoneal Shunting","volume":"55","author":"Thiessen","year":"1998","journal-title":"Arch Neurol"},{"key":"B32","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.1998.16.6.2195","article-title":"Effects of Radiation and Chemotherapy on Cognitive Function in Patients With High-Grade Glioma","volume":"16","author":"Taylor","year":"1998","journal-title":"J Clin Oncol"},{"key":"B33","doi-asserted-by":"publisher","DOI":"10.1080\/02688699908540622","article-title":"Mood Disorders in Patients After Treatment for Primary Intracranial Tumours","volume":"13","author":"Anderson","year":"1999","journal-title":"Br J Neurosurg"},{"key":"B34","doi-asserted-by":"publisher","DOI":"10.1007\/s11764-017-0602-7","article-title":"Life Beyond a Diagnosis of Glioblastoma: A Systematic Review of the Literature","volume":"11","author":"Gately","year":"2017","journal-title":"J Cancer Survivorship"},{"key":"B35","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12987-018-0101-x","article-title":"Challenges in Cerebrospinal Fluid Shunting in Patients With Glioblastoma","volume":"15","author":"Hong","year":"2018","journal-title":"Fluids Barriers CNS"},{"key":"B36","doi-asserted-by":"publisher","first-page":"e01125","DOI":"10.1002\/brb3.1125","article-title":"Improved Lumbar Infusion Test Analysis for Normal Pressure Hydrocephalus Diagnosis","volume":"8","author":"Ryding","year":"2018","journal-title":"Brain Behav"},{"key":"B37","doi-asserted-by":"publisher","DOI":"10.1007\/s10143-019-01201-5","article-title":"Normal Pressure Hydrocephalus\u2014 An Overview of Pathophysiological Mechanisms and Diagnostic Procedures","volume":"43","author":"Skalick\u00fd","year":"2020","journal-title":"Neurosurgical Rev"},{"key":"B38","doi-asserted-by":"publisher","first-page":"697","DOI":"10.3171\/jns.1971.34.5.0697","article-title":"Glioblastoma With Extracranial Metastasis Through Ventriculopleural Shunt. Case Report","volume":"34","author":"Wakamatsu","year":"1971","journal-title":"J Neurosurg"},{"key":"B39","doi-asserted-by":"publisher","DOI":"10.1007\/s003810050166","article-title":"Abdominal Metastases of Pediatric Brain Tumors via Ventriculo- Peritoneal Shunts","volume":"14","author":"Rickert","year":"1998","journal-title":"Child\u2019s Nerv Syst"},{"key":"B40","doi-asserted-by":"publisher","DOI":"10.1002\/ccr3.1980","article-title":"Extracranial Metastases in Glioblastoma\u2014Two Case Stories","volume":"7","author":"Schou N\u00f8r\u00f8xe","year":"2019","journal-title":"Clin Case Rep"},{"key":"B41","doi-asserted-by":"publisher","DOI":"10.1159\/000028870","article-title":"Thalamic Glioblastoma With Cerebrospinal Fluid Dissemination in the Peritoneal Cavity","volume":"31","author":"Kumar","year":"1999","journal-title":"Pediatr Neurosurg"},{"key":"B42","doi-asserted-by":"publisher","DOI":"10.1002\/1097-0142(19800415)45:8<2220::AID-CNCR2820450835>3.0.CO;2-Q","article-title":"Evaluation of Patients With Advanced Cancer Using the Karnofsky Performance Status","volume":"45","author":"Yates","year":"1980","journal-title":"Cancer"},{"key":"B43","article-title":"Issues in Assessing and Interpreting Quality of Life in Patients With Malignant Glioma","volume":"27","author":"Gilbert","year":"2000","journal-title":"Semin Oncol"},{"key":"B44","doi-asserted-by":"publisher","first-page":"29","DOI":"10.3171\/jns.1996.84.1.0029","article-title":"Psychosocial Functioning and Quality of Life in Patients With Primary Brain Tumors","volume":"84","author":"Weitzner","year":"1996","journal-title":"J Neurosurg"},{"key":"B45","doi-asserted-by":"publisher","DOI":"10.1093\/neuros\/nyy098","article-title":"The Neurologic Assessment in Neuro-Oncology (NANO) Scale as an Assessment Tool for Survival in Patients With Primary Glioblastoma","volume":"84","author":"Ung","year":"2019","journal-title":"Clin Neurosurg"},{"key":"B46","doi-asserted-by":"publisher","DOI":"10.3171\/2018.5.JNS1875","article-title":"Outcomes and Complications of Different Surgical Treatments for Idiopathic Normal Pressure Hydrocephalus: A Systematic Review and Meta-Analysis","volume":"131","author":"Giordan","year":"2019","journal-title":"J Neurosurg"}],"container-title":["Frontiers in Oncology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2022.796105\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,2,9]],"date-time":"2022-02-09T14:17:58Z","timestamp":1644416278000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2022.796105\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,2,9]]},"references-count":46,"alternative-id":["10.3389\/fonc.2022.796105"],"URL":"https:\/\/doi.org\/10.3389\/fonc.2022.796105","relation":{},"ISSN":["2234-943X"],"issn-type":[{"value":"2234-943X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,2,9]]},"article-number":"796105"}}