Communicating Hydrocephalus and Vestibular Schwannomas: Etiology, Treatment, and Long-Term Follow-Up

Abstract

Background Large vestibular schwannomas (VSs) can cause hydrocephalus by obstructing the fourth ventricle. Little is known about the communicating hydrocephalus that is seen with a smaller VS. Methods The clinicopathological findings and follow up of three patients with communicating hydrocephalus associated with a small VS are presented. Results Four patients aged 40 to 66 years (mean: 57.7) presented with ataxia, dementia, and urinary incontinence. The VS were 2.0 to 2.4 cm. The cerebrospinal fluid (CSF) protein was elevated in three patients in whom it was measured (1.7 to 6 times normal). The VS was resected in two patients. All of the patients required ventriculoperitoneal shunting (VPS). All of the patients were asymptomatic or improved at follow-up at 9 months to 13 years. Conclusion Communicating hydrocephalus associated with a VS can occur in younger patients than was previously thought. An elevated CSF protein appears to be important, but other factors may be involved. A shunting procedure is often required to relieve the symptoms of hydrocephalus even if the tumor is resected. Possible etiological causes of communicating hydrocephalus in patients with a small VS are discussed.

Analysis of risk factors to predict communicating hydrocephalus following gamma knife radiosurgery for intracranial schwannoma

“…Incidence and pathogenesis of HCP in intracranial schwannoma patients VS-associated HCP has been reported in many studies, with an incidence ranging from 3.7 to 23.5% [9,10].…”

“…VS‐associated HCP has been reported in many studies, with an incidence ranging from 3.7 to 23.5% . Meanwhile, HCP in non‐VS patients is not common and has only been reported in a few studies with very small patient samples .…”

“…There is little information about the underlying mechanisms that lead to development of communicating HCP following GKRS. One possible contributing factor may be high protein concentration in the CSF [4,[6][7][8][9]. In our previous study, we found that large volume tumors and tumors undergoing temporary size changes were correlated with higher incidence of communicating HCP [10].…”

Headache, Cerebrospinal Fluid Leaks, and Pseudomeningoceles after Resection of Vestibular Schwannomas: Efficacy of Venous Sinus Stenting Suggests Cranial Venous Outflow Compromise as a Unifying Pathophysiological Mechanism

“…6 Regarding CSF leaks and pseudomeningoceles, communicating hydrocephalus has been observed in relation to vestibular schwannomas at presentation, associated with elevated CSF protein levels, and it has been proposed that this reflects accumulation of tumor debris in the CSF, which interferes with CSF absorption. [11][12][13] One could speculate further that a similar mechanism might apply in patients who show no hydrocephalus preoperatively, the underlying problem eventually declaring itself as delayed healing of an iatrogenic dural defect. 14 We have seen narrowing of the sigmoid sinus where it crosses the craniectomy defect following vestibular schwannoma surgery and published a report in which repair of this narrowing by stenting brought about resolution of postoperative headache.…”

Hydrocephalies and Vestibular Schwannoma of Great Size: Therapeutic Strategies: About a Series of 32 Cases

“…The optimal resection of the schwannoma could avoid unnecessary placement of a ventricular shunt and thus reduce the possible stresses and complications associated with the presence of this device [11]. In case of post-operative persistence of signs related to CSF hydrodynamic disturbances, a derivation may be considered [20]. In the literature, the incidence of patients requiring shunt placement for post-tumor resection hydrocephalus varies between 3.8% and 29.2% [8] [16] [21] and 9.5% in our study.…”