Posterior cranial fossa tumours frequently develop hydrocephalus as first presentation in up to 80% of paediatric patients and 21.4% of adults, although it resolves after tumour removal in 70–90% and 96%, respectively. New onset hydrocephalus is reported in about 2.1% of adult and 10–40% of paediatric patients after posterior fossa surgery. There is no consensus concerning prophylactic external ventricular drainage (EVD) placement that is frequently used before posterior fossa lesion removal, as well in those cases without clear evidence of hydrocephalus. The aim of the study was to define the most correct management for patients who undergo posterior fossa tumour surgery, thus identifying cohorts of patients who are at risk of persistent hydrocephalus prior to surgery. A systematic review of literature has been performed, following PRISMA guidelines. Most of the studies reported CSF shunt only in the presence of hydrocephalus, whereas only a few authors suggested its prophylactic use in the absence of signs of ventricular dilatation. Predictive factors for postoperative hydrocephalus has been identified, including young age (< 3 years), severe symptomatic hydrocephalus at presentation, EVD placement before surgery, FOHR index > 0.46 and Evans index > 0.4, pseudomeningocele, CSF leak and infection. The use of pre-resection CSF shunt in case of signs and symptoms of hydrocephalus is mandatory, although it resolves in the majority of cases. As reported by several studies included in the present review, we suggest CSF shunt also in case of asymptomatic hydrocephalus, whereas it is not indicated without evidence of ventricular dilatation.

颅后窝窝肿瘤首先在80％的儿科患者和21.4％的成年人中首先出现脑积水，尽管在切除肿瘤后分别消退了70-90％和96％。后颅窝手术后，约有2.1％的成年人和10％至40％的小儿患者发生新的脑积水。对于在切除颅后窝病变之前经常使用的预防性室外引流术（EVD）以及没有明显脑积水的病例，尚无共识。该研究的目的是为接受后颅窝肿瘤手术的患者定义最正确的治疗方法，从而确定在手术前有持续性脑积水风险的患者人群。对文献进行了系统的审查，遵循PRISMA准则。大多数研究报告仅在存在脑积水的情况下进行脑脊液分流，而只有少数作者建议在没有心室扩张迹象的情况下预防性使用脑脊液。已确定了术后脑积水的预测因素，包括年龄小于3岁，出现严重症状性脑积水，术前EVD放置，FOHR指数> 0.46和Evans指数> 0.4，假性脑膜膨出，脑脊液漏出和感染。在脑积水的体征和症状的情况下，必须使用切除前脑脊液分流器，尽管在大多数情况下可以解决。正如本综述中包括的几项研究所报道的，我们建议在无症状脑积水的情况下也进行脑脊液分流术，而没有心室扩张的证据则不建议使用。大多数研究报告仅在存在脑积水的情况下进行脑脊液分流，而只有少数作者建议在没有心室扩张迹象的情况下预防性使用脑脊液。已确定了术后脑积水的预测因素，包括年龄小于3岁，出现严重症状性脑积水，术前EVD放置，FOHR指数> 0.46和Evans指数> 0.4，假性脑膜膨出，脑脊液漏出和感染。在脑积水的体征和症状的情况下，必须使用切除前脑脊液分流器，尽管在大多数情况下可以解决。正如本综述中包括的几项研究所报道的，我们建议在无症状脑积水的情况下也进行脑脊液分流术，而没有心室扩张的证据则不建议使用。大多数研究报告仅在存在脑积水的情况下进行脑脊液分流，而只有少数作者建议在没有心室扩张迹象的情况下预防性使用脑脊液。已确定了术后脑积水的预测因素，包括年轻年龄（<3岁），就诊时出现严重症状性脑积水，术前EVD放置，FOHR指数> 0.46和Evans指数> 0.4，假性脑膜膨出，脑脊液漏出和感染。在脑积水的体征和症状的情况下，必须使用切除前脑脊液分流器，尽管在大多数情况下可以解决。正如本综述中包括的几项研究所报道的，我们建议在无症状脑积水的情况下也进行脑脊液分流术，而没有心室扩张的证据则不建议使用。