This study aims to present and analyze the institutional experience in the diagnosis, treatment, and postoperative outcomes of infantile brain tumors. A retrospective review was conducted of medical records of infants (aged ≤ 1 year) who underwent initial surgical treatment of supratentorial brain tumors between 2002 and 2024. Indications for tumor resection included mass effect, symptomatic lesions (e.g., increased intracranial pressure [ICP] or focal deficits), or radiologically confirmed tumor progression. Continuous data were summarized as medians or means and categorical variables as counts and percentages. Survival analyses were performed using the Kaplan-Meier method with log-rank testing, while Cox regression, logistic models, and Fisher's exact test assessed prognostic and functional associations (P < 0.05, Jamovi v2.6). Our analysis included 34 infants. Signs of ICP were observed in 65% of patients. Tumors were predominantly intraventricular (38%), with choroid plexus tumors being the most common (38%). The median follow-up was 48 months. Gross total resection was achieved in 58% of initial resections, while high-grade histopathology was independently correlated with incomplete tumor removal (P = 0.016). Additionally, high-grade tumors were also associated with poorer prognosis, with a 5-year overall survival of 63% compared to 100% for low-grade tumors. In our institutional experience, infants with supratentorial tumors often presented with late, nonspecific symptoms related to increased ICP. Surgical treatment focused on maximal safe resection, although complete removal was not always feasible in a single procedure.

Endoscopic third ventriculostomy (ETV) is a well-established treatment for obstructive hydrocephalus, offering durable cerebrospinal fluid diversion without the long-term risks of shunt dependency. While prognostic factors such as patient age, etiology, ETV Success Score (ETV-SS), and radiological signs of third ventricle bowing are validated in pediatric cohorts, their predictive value in adults and elderly patients remains unclear. Adult patients diagnosed with obstructive hydrocephalus and consecutively treated with primary ETV were retrospectively evaluated. The primary endpoint was the evaluation of preoperative predictors of shunt failure in adult and elderly patients undergoing primary ETV after a long-term follow-up. ETV-SS and radiological parameters including ventricular morphometrics were preoperatively evaluated. Outcomes included postoperative clinical improvement, complications, and rate of ETV failure requiring revision surgery. A total of 51 patients (mean age 60 ± 16 years) were included, with a median follow-up of 24 months. Most patients presented with high preoperative ETV-SS (≥80). Favorable outcomes with effective stoma patency were achieved in 85% of the cases. Overall, 8 (16%) patients required revision surgery for ETV failure, with a median interval to surgical revision of 6.5 months. ETV-SS, age, gender, etiology, and ventricular morphometrics showed limited correlation with long-term outcome. In adult and elderly patients undergoing primary ETV for obstructive hydrocephalus, none of the evaluated prognostic factors - including the ETV-SS, hydrocephalus etiology, and third ventricle morphometrics - were predictive of postoperative outcome. ETV was shown to be a safe and effective treatment across age groups and preoperative diagnoses.

Valve technology for ventriculoperitoneal shunting in idiopathic normal pressure hydrocephalus (iNPH) has evolved considerably, yet the comparative clinical impact of programmable flow-regulated valve (FV) versus gravitational valve (GV) remains unclear. We aimed to assess the long-term safety, effectiveness, and complication rates of these 2 valve types over a 3-year follow-up in a large cohort of iNPH patients. We retrospectively analyzed 212 adults diagnosed with probable iNPH and treated with adjustable VPS using either FV (n = 136) or GV (n = 76). The primary outcome was clinical improvement based on the iNPH grading scale. Secondary outcomes included postoperative complications, valve dysfunction, number of setting adjustments, changes in differential pressure unit values, and the influence of preoperative factors on outcomes. Significant clinical improvement was observed in both groups (P < 0.001), with no significant difference in iNPH grading scale scores between valves (P = 0.124). However, patients treated with FV had a significantly higher rate of postoperative complications (P = 0.019), particularly valve dysfunction (P = 0.029). Postoperative pressure adjustments led to greater differential pressure unit reductions in the GV group (P < 0.05), though the number of adjustments was similar. Preoperative factors (age, sex, and initial pressure) were not associated with outcome differences. In our institutional experience, both FV and GV were effective in the treatment of iNPH, with comparable clinical outcomes. GV were associated with fewer late complications, suggesting a potentially more favorable long-term safety profile. However, given the observational nature of this study, causal inference is limited, and prospective studies are required to validate these findings.