Anatomical and surgical factors associated with postoperative hydrocephalus after central neurocytoma resection: a large single-center cohort study
TL;DR
TC and TVI were consistently associated with subsequent hydrocephalus-related outcomes, findings that may inform closer postoperative surveillance.
Abstract
Postoperative hydrocephalus after central neurocytoma (CN) resection may persist despite tumor removal. This study evaluated anatomical and surgical factors associated with postoperative hydrocephalus-related outcomes. Patients with pathologically confirmed CN who underwent tumor resection between 2011 and 2025 were retrospectively analyzed. The primary outcomes were composite postoperative hydrocephalus, radiographic hydrocephalus at latest follow-up, and hydrocephalus-related revision surgery (HRRS). Associations were evaluated using multivariable logistic and Cox regression with consideration of surgeon-level clustering. Propensity score matching was used to improve comparability between the transcortical (TC) and interhemispheric transcallosal (ITC) groups, and spontaneous remission was additionally assessed using competing-risk analysis. Among 652 screened patients, 454 were included in the descriptive cohort and 406 in the complete-case analytical cohort; propensity score matching yielded 119 pairs. Mean follow-up was 85.50 ± 49.94 months. Immediate postoperative hydrocephalus rates were similar between approaches, whereas composite postoperative hydrocephalus was more frequent after TC in both the descriptive cohort (31.60% vs. 17.01%; P = .002) and matched cohort (33.61% vs. 21.01%; P = .042). In adjusted analyses, TC was associated with composite hydrocephalus (adjusted OR, 2.28; 95% CI, 1.34–3.89), radiographic hydrocephalus at latest follow-up (adjusted OR, 2.30; 95% CI, 1.20–4.40), and HRRS (adjusted HR, 2.25; 95% CI, 1.07–4.74). Third ventricular invasion (TVI) was also associated with all three outcomes. Among patients with immediate postoperative hydrocephalus, spontaneous remission was less frequent after TC, with consistent findings in the competing-risk analysis (adjusted SHR, 0.57; 95% CI, 0.33–0.98). Postoperative hydrocephalus after CN resection showed temporal divergence between immediate and later postoperative assessments. TC and TVI were consistently associated with subsequent hydrocephalus-related outcomes, findings that may inform closer postoperative surveillance.