Fluid-fluid level in cystic vestibular schwannoma: a predictor of peritumoral adhesion

Abstract

Object. The aim of this study was to evaluate the clinical results and surgical outcomes of cystic vestibular schwannomas (VSs) with fluid-fluid levels.Methods. Forty-five patients with cystic VSs and 86 with solid VSs were enrolled in the study. The patients in the cystic VSs were further divided into those with and without fluid-fluid levels. The clinical and neuroimaging features, intraoperative findings, and surgical outcomes of the 3 groups were retrospectively compared.Results. Peritumoral adhesion was significantly greater in the fluid-level group (70.8%) than in the nonfluidlevel group (28.6%) and the solid group (25.6%; p < 0.0001). Complete removal of the VS occurred significantly less in the fluid-level group (45.8%, 11/24) than in the nonfluid-level group (76.2%, 16/21) and the solid group (75.6%, 65/86; p = 0.015). Postoperative facial nerve function in the fluid-level group was less favorable than in the other 2 groups; good/satisfactory facial nerve function 1 year after surgery was noted in 50.0% cases in the fluid-level group compared with 83.3% cases in the nonfluid-level group (p = 0.038).Conclusions. Cystic VSs with fluid-fluid levels more frequently adhered to surrounding neurovascular structures and had a less favorable surgical outcome. A possible mechanism of peritumoral adhesion is intratumoral hemorrhage and consequent inflammatory reactions that lead to destruction of the tumor-nerve barrier. These findings may be useful in predicting surgical outcome and planning surgical strategy preoperatively. 197Abbreviations used in this paper: DRIVE = driven equilibrium; PICA = posterior inferior cerebellar artery; TSE = turbo spin echo; VS = vestibular schwannoma.

Multicystic vestibular schwannomas with fluid-fluid levels: A report of three cases

“…However, determination of the fundamental causes and implications of fluid-fluid levels using biochemistry may be required. VSs with fluid-fluid levels are not appropriate for 'watch and wait' treatment approaches due to the relatively high probability of sudden tumor enlargement due to hemorrhage (3,5,15). Furthermore, radiosurgery is not recommended, as the expansion of the cystic components and possible hemorrhage following radiosurgery may result in sudden deterioration (2, 16,17).…”

“…For instance, Sommer et al (5) proposed that fluid-fluid levels in hepatic metastases are a characteristic indication of metastases of neuroendocrine origin. In addition, Xia et al (3) determined that fluid-fluid levels in VSs were a predictor of peritumoral adhesion and are associated with a less favorable surgical outcome. In agreement with this, VS with fluid-fluid levels adhered to the facial nerve, other cranial nerves or the brain stem were observed during the surgical procedures performed in the current cases.…”

“…Previous studies have reported fluid-fluid levels in non-neurogenic tumors (4,5), as well as a small number of cranial nerve schwannomas, including trigeminal, glossopharyngeal and hypoglossal schwannomas (6)(7)(8). However, cystic VSs with fluid-fluid levels are fairly rare (3,6,9,10).…”

“…Cystic VSs are relatively less common than solid VSs, with a reported incidence rate ranging between 5.7 and 24% (2). Furthermore, cystic VSs are more aggressive than solid VSs due to the rapid growth and unpredictable expansion of their cystic component (2, 3).…”

Peritumoral cystic meningioma: A report of two cases and review of the literature

“…A contrast-enhanced MRI scan ( Fig. 1A and B) was performed using 10 ml gadolinium-diethylenetriaminepentaacetic acid (Bayer AG, Leverkusen Germany) and reported according to previous studies (12,13). The MRI scan revealed a large, homogeneously enhancing lesion with multiple cysts with wall enhancement in the right hemisphere.…”