Modified Torkildsen shunt as a prophylactic procedure for postoperative hydrocephalus in fourth ventricular tumors

Abstract Introduction: Surgery for fourth ventricular tumors is plagued by potential CSF blockage after the tumor removal due to a plethora of reasons. We re-invented the classic Torkildsen shunt as a treatment for postoperative hydrocephalus after fourth ventricular tumor removal by placing a catheter from the aqua duct through fourth ventricle towards the cisterna magna. Materials and methods We prospectively gathered the data of patients who underwent surgery of the fourth ventricle tumor between January 2019 and December 2021 at the Department of Neurosurgery in West China Hospital of Sichuan University. In all, a total of 96 selective cases were selected among 237 fourth ventricle tumor cases because of their superior tumor extension into the aqueduct. The patients were categorized into modified Torkildsen and no modified Torkildsen groups and risks factors for the development of postoperative hydrocephalus evaluated and their clinical outcomes were compared. Result In all 20 patients developed postoperative hydrocephalus out of the 96 patients included in the study. All the 20 patients who developed postoperative hydrocephalus were in the no modified Torkildsen group. No patient in the modified Torkildsen group developed postoperative hydrocephalus. Thus, we observed a significate statistical difference between the modified Torkildsen group and no modified Torkildsen group (p = 0.0062). Conclusion The modified Torkildsen shunt can be effective in preventing postoperative hydrocephalus in selected fourth tumor patients. The procedure enables one to avoid a standard ventriculoperitoneal (VP) shunt or endoscopic third ventriculostomy (ETV), especially in cases whose tumors extended superiorly and were not totally resected.