Anatomical and surgical factors associated with postoperative hydrocephalus after central neurocytoma resection: a large single-center cohort study.

PURPOSE: 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. METHODS: 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. RESULTS: 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). CONCLUSION: 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.