Hydrocephalus Associated with Large Vestibular Schwannoma: Management Options and Factors Predicting Requirement of Cerebrospinal Fluid Diversion after Primary Surgery

Prabhuraj, A R; Sadashiva, Nishanth; Kumar, Santhosh; Shukla, Dhaval; Bhat, Dhananjaya I; Devi, Bhagavatula Indira; Somanna, Sampath

doi:10.4103/jnrp.jnrp_264_17

Cited by 13 publications

(6 citation statements)

References 16 publications

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“…At present, the main treatment strategies for this disease are follow-up observation, microsurgical resection, stereotactic radiotherapy, etc. Compared with the other two groups of treatment strategies, surgical resection can effectively reduce tumor volume and solve complications [ 2 , 3 ] and greatly improve the postoperative quality of life of patients. Therefore, surgery is now widely accepted by both doctors and patients as the preferred method.…”

Section: Introductionmentioning

confidence: 99%

Analysis of Related Factors Affecting Facial Nerve Function after Acoustic Neuroma Surgery

Liu

Shen

Han

et al. 2022

Evidence-Based Complementary and Alternative Medicine

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Objective. To investigate the factors affecting facial nerve function after acoustic neuroma surgery and to provide theoretical reference for clinicians to preserve facial nerve function better after surgery. Methods. A retrospective cohort study was conducted to analyze the correlation between postoperative facial nerve function and surgical approach, age, sex, tumor size and adhesion degree of facial nerve in 152 patients with acoustic neuroma. Results. In the choice of surgical approach, there was no significant difference in the anatomy of the complete facial nerve in labyrinth path, retrosigmoid sinus path, and middle cranial fossa path. There was no statistically significant difference between the middle cranial fossa path and the retrosigmoid sinus path in facial nerve function preservation 7 days after surgery. The difference between middle cranial fossa path and labyrinthine path was statistically significant ( P < 0.01 ). There were statistically significant differences between labyrinth path and retrosigmoid sinus path ( P < 0.05 ). Logistic multivariate regression analysis showed that the operative approach and the degree of adhesion between tumor and facial nerve were the risk factors affecting functional preservation of facial nerve 7 days after surgery. Age and the degree of adhesion between tumor and facial nerve were the risk factors for functional preservation of facial nerve 1 year after operation. Conclusion. The facial nerve function injury in patients with acoustic neuroma may be related to the choice of surgical approach, the adhesion degree of tumor and facial nerve, and their age. Clinicians need to comprehensively evaluate the risk factors before surgery, so as to achieve individualized treatment to protect the integrity of postoperative facial nerve function of patients.

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Section: Introductionmentioning

confidence: 99%

Analysis of Related Factors Affecting Facial Nerve Function after Acoustic Neuroma Surgery

Liu

Shen

Han

et al. 2022

Evidence-Based Complementary and Alternative Medicine

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“…Development or possible exacerbation of hydrocephalus after gamma knife radio surgical procedure is evident from this case report. Albeit causal relationship between incidence of hydrocephalus in association with procedure is not well established yet the timeline of incidence of hydrocephalus tallies with other cases reported earlier declaring same association [8][9][10]. in majority of VS associated hydrophiles developed within one and half year [11,12].…”

Section: Discussionmentioning

confidence: 80%

An MR Imaging Study of Communicating Hydrocephalus After Gamma Knife Radiosurgery for Vestibular Schwannoma

Melese,

Alhussain,

Ayalew

et al. 2024

EJPM

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Patients with vestibular schwannoma (VS) face a 3.7-23.7% risk developing hydrocephalus. Small-sized VS are associated with communicating or non-communicating hydrocephalus. Hydrocephalus in VS patients can persist or worsen post-tumor removal. Gamma knife radiosurgery is effective, especially in younger patients with functional hearing. Although the causal relationship between gamma knife radiosurgery and hydrocephalus isn't firmly established, this case reports a possible association between developing hydrocephalus and Vestibular schwannoma. Elevated CSF protein suggests communicating hydrocephalus due to tumor necrosis. The rarity of hydrocephalus post-gamma knife surgery likely relates to tumor variations rather than procedural nuances. Gamma Knife radiosurgery for vestibular schwannomas can lead to communicative hydrocephalus. MR imaging, including pre- and post-treatment scans, along with MR CSF cine-flow studies, highlights the link between gamma knife involvement and hydrocephalus development. Despite the rarity, this negative outcome underscores the need for careful consideration and investigation of risk factors associated with hydrocephalus post-radiosurgery. A middle aged man with vestibular schwannoma was investigated in this case. Patient was procedure through gamma knife radiosurgery for vestibular schwannoma. Patient was passed through MR scans before the radio surgical procedure and 9 months past surgical procedure. Nine months later, severe ventriculomegaly was observed, revealing central necrosis in the tumor. Lumbar puncture indicated abnormal CSF characteristics without evidence of infection. Despite a failed endoscopic third ventriculostomy, MR imaging cine-flow studies confirmed free CSF flow, emphasizing the complexity of managing hydrocephalus post-gamma knife radiosurgery for vestibular schwannomas. VS typically occurs in older individuals, this case's younger age and optimal tumor size for gamma knife treatment add complexity. Faster-growing and larger tumors are more prone to post-treatment necrosis and hydrocephalus, necessitating careful management. MR cine-flow aids in hydrocephalus differentiation.

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“…Nevertheless, in situations of long waiting list for the patients; leaving the patients with hydrocephalic manifestations untreated may cause deterioration of the clinical manifestations with increased negative influence on the surgical outcome and external ventricular drain insertion for those cases is associated with higher morbidity due to long standing external ventricular drain [8]…”

Section: Discussionmentioning

confidence: 99%

Microsurgical Management of Vestibular Schwannomas with Brainstem Compression: Surgical Challenges and Outcome

Saad¹,

Shata²,

Younis³

et al. 2020

OJMN

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Background: Vestibular schwannomas exerting brainstem compression with or without hydrocephalus are challenging for neurosurgeons regarding the plan of surgery, operative risk and postoperative sequale. Purpose: To report our experience with the surgical challenges and outcomes for Hannover type T4a & T4b vestibular schwannomas. Methods: Retrospective case study conducted at neurosurgery department, Mansoura University between October 2016 and May 2019 of 16 patients with vestibular schwannoma compressing the brainstem. We reviewed their clinical, radiological, surgical data, incidence of complications and outcome. Results: We had 16 patients: 10 of Hanover grade T4b and 6 of grade T4a. Gross total resection was achieved in 2 cases while subtotal resection was achieved in 5 cases and in the remaining 9 cases; only partial resection was feasible. We had 4 cases of mortality. Among new onset morbidity after surgery, 3 cases had post-operative bulbar manifestation and 4 cases had brainstem dysfunction. Conclusion: Vestibular schwannomas compressing the brain stem are challenging in their clinical presentation, surgery and post-operative outcome. The outcome of patients treated with hydrocephalus prior to vestibular schwannoma surgery is better than those who did initial VS surgery. Patients presented with significant brainstem, bulbar manifestation had worse outcome and needed longer ICU stay and longer time for recovery.

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Hydrocephalus Associated with Large Vestibular Schwannoma: Management Options and Factors Predicting Requirement of Cerebrospinal Fluid Diversion after Primary Surgery

Cited by 13 publications

References 16 publications

Analysis of Related Factors Affecting Facial Nerve Function after Acoustic Neuroma Surgery

Analysis of Related Factors Affecting Facial Nerve Function after Acoustic Neuroma Surgery

An MR Imaging Study of Communicating Hydrocephalus After Gamma Knife Radiosurgery for Vestibular Schwannoma

Microsurgical Management of Vestibular Schwannomas with Brainstem Compression: Surgical Challenges and Outcome

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