PITCH (pediatric infratentorial tumors – hydrocephalus-related complications) registry study design: observational, prospective, multicenter study evaluating the number of surgeries associated with the treatment of hydrocephalus secondary to infratentorial tumors in childhood and adolescence

INTRODUCTION: Posterior fossa tumors are the most common solid pediatric neoplasms, and more than 60% of these tumors are associated with hydrocephalus, which can be managed using different strategies, including endoscopic third ventriculostomy (ETV), ventriculoperitoneal shunt (VPS), external ventricular drainage (EVD), or direct tumor resection without CSF diversion. The safest and most effective drainage method remains controversial, and most available studies are limited to single-center retrospective analyses, often constrained by small sample sizes. Therefore, multicenter prospective studies are needed to determine the optimal treatment strategy. METHODS: This is a prospective, multicenter cohort study conducted across more than 20 pediatric neurosurgery centers in Latin America. Patients will be allocated into four groups according to the treatment selected for hydrocephalus (ETV, EVD, VPS, or resection). The primary outcome will be the number of surgical interventions related to the treatment of hydrocephalus during the follow-up period. Secondary outcomes will include mortality, infection, and other clinically relevant complications, analyzed as complementary endpoints. Patients will be followed prospectively for up to 12 months after the index procedure, defined as the intervention performed for the treatment of hydrocephalus, and each group will include at least 50 patients. CONCLUSION: The REDCap online platform will be used for data collection in the PITCH study, enabling prospective data acquisition across multiple centers in Latin America. This will allow comparison of treatment modalities for obstructive hydrocephalus secondary to posterior fossa tumors (ETV, EVD, VPS, and resection) and evaluation of their impact during the first year after diagnosis.