Hydrocephalus associated with vestibular schwannomas: management options and factors predicting the outcome

Abstract

Object The current, generally accepted optimal management for hydrocephalus related to vestibular schwannomas (VSs) is primary tumor removal, with further treatment reserved only for patients who remain symptomatic. Previous studies have shown, however, that this management can lead to an increase in surgery-related complications. In this study, the authors evaluated their experience with the treatment of such patients, with the aim of identifying the following: 1) the parameters correlating to the need for specific hydrocephalus treatment following VS surgery; and 2) patients at risk for developing hydrocephalus-related complications. Methods This was a retrospective study of a 400-patient series. The complication rates and outcomes following primary hydrocephalus treatment versus primary VS removal were compared. Patients undergoing primary tumor removal were further subdivided on the basis of the need for subsequent hydrocephalus treatment. The 3 categories of parameters tested for correlation with the need for such subsequent treatment as well as with heightened risk for developing complications were patient-, tumor-, and hydrocephalus-related. Results Of the entire series, 53 patients presented with hydrocephalus. Forty-eight of 53 patients underwent primary VS surgery, of whom 42 (87.5%) did not require additional hydrocephalus treatment. Of the 6 patients who did require additional hydrocephalus treatment, only 3 ultimately required a VP shunt. Factors correlating to the need of hydrocephalus treatment after VS removal were large tumor size, irregular tumor surface, and severe preoperative hydrocephalus. Patients with a longer symptom duration prior to surgery, those with polycyclic tumors, or with inhomogeneous VS, were at heightened risk for the development of CSF leaks. The general and functional outcome of surgery showed no correlation to the presence of preoperative hydrocephalus. Conclusions Primary tumor removal is the optimum management of disease in patients with VS with associated hydrocephalus; it leads to resolution of the hydrocephalus in the majority of cases, and the outcome is similar to that of patients without hydrocephalus. Certain factors may aid in identifying patients at risk for developing persistent hydrocephalus as well as those at risk for CSF leaks.

Technical nuances of resection of giant (> 5 cm) vestibular schwannomas: pearls for success

“…As expected, increased tumor size is a risk factor for development of postoperative hydrocephalus. 10 If symptomatic obstructive hydrocephalus is present, we prefer to place an external ventricular drain at the time of craniotomy with the goal of weaning the drain postoperatively, if possible, and shunt placement if necessary. In the particular case described in the accompanying video, due to the patient's gravid state and associated risks, an initial shunting procedure was performed to temporize the patient's symptoms until postpartum to allow for delayed tumor resection.…”

A study assessing the post operative outcome in patients of acoustic schwannoma operated through retrosigmoid approach at tertiary care institutions- An experience of one year

“…The incidence of preoperative shunting was as high as 66% in the series reported by Ramamurthy. 4 Gerganov VM et al 10 recommended placement of external ventricular drainage (EVD) or VP shunt prior to surgery as surgery in patients with hydrocephalus and increased ICP is presumably more challenging, and related to worse outcome or higher complication rates. They found that the general and functional outcome in patients with primary VS removal is independent of the presence of hydrocephalus.…”

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

“…The presence of schwannoma outside the blood-brain barrier allows blood proteins to pass through the cleft and interendothelial junctions of the tumor to the surrounding CSF [12]. Communicating hydrocephalus is thought to be predominant in older SV carriers [10] [16]. We will simply say that the presence of the neuroma is a predisposing factor to hydrocephalus whatever the age.…”