Large vestibular schwannomas and hydrocephalus: Lessons learnt from a single centre experience

Abstract

Aim

The aim of the following study is to analyze the outcome following surgery in 169 patients with large vestibular schwannoma (VS) and to evaluate hydrocephalus as a prognostic factor in patients of the VSs.

Subjects and Methods

Retrospective analysis of all cases of VSs admitted to our tertiary neurosurgical center from January 2005 to December 2010 was performed. Comparison of patients who underwent pre-operative cerebrospinal fluid (CSF) diversion and those who underwent primary surgery was carried out for post-operative complications and delayed hydrocephalus.

Results

A total of 169 patients of VS were seen. The mean age at presentation was 39.03 years (12-72 years). The most common symptom was hearing loss seen in 161 (95.2%) cases. Giant VS was seen in 130 (75.5%) and hydrocephalus was present in 110 (63.9%). Pre-operative CSF diversion was done in 23 (13.1%) patients; 8 (4.6%) patients developed gradually symptomatic hydrocephalus following surgery and underwent ventriculoperitoneal shunt. Total surgical excision was done in 92.9% patients and subtotal excision was done in 7% patients.

Conclusions

Hydrocephalus occurs in longstanding untreated cases of VS. Hydrocephalus causes no statistically significant increase in post-operative complications like CSF leak and post-operative hematoma. Patients with hydrocephalus presenting with acute symptoms of raised intracranial pressure benefit from CSF diversion. In most patients, tumor resection will restore patency of the CSF pathway and CSF diversion can be avoided.

Key words

Hydrocephalus - retromastoid craniectomy - ventriculoperitoneal shunt - vestibular schwannoma

• References

• 1 Jain VK, Mehrotra N, Sahu RN, Behan S, Banerji D, Chhabra DK. Surgery of vestibular schwannomas: An institutional experience. Neurol India 2005; 53: 41-45
• 2 Mehrotra N, Behan S, Pal L, Banerji D, Sahu RN, Jain VK. Giant vestibular schwannomas: Focusing on the differences between the solid and the cystic variants. Br J Neurosurg 2008; 22: 550-556
• 3 Sahu RN, Mehrotra N, Tyagi I, Banerji D, Jain VK, Behari S. Management strategies for bilateral vestibular schwannomas. J Clin Neurosci 2007; 14: 715-722
• 4 Gerganov VM, Pirayesh A, Nouri M, Hore N, Luedemann WO, Oi S. et al Hydrocephalus associated with vestibular schwannomas: Management options and factors predicting the outcome. J Neurosurg 2011; 114: 1209-1215
• 5 Pirouzmand F, Tator CH, Rutka J. Management of hydrocephalus associated with vestibular schwannoma and other cerebellopontine angle tumors. Neurosurgery 2001; 48: 1246-1253
• 6 Samii M, Gerganov VM, Samii A. Functional outcome after complete surgical removal of giant vestibular schwannomas. J Neurosurg 2010; 112: 860-867
• 7 Fukuda M, Oishi M, Kawaguchi T, Watanabe M, Takao T, Tanaka R. et al Etiopathological factors related to hydrocephalus associated with vestibular schwannoma. Neurosurgery 2007; 61: 1186-1192
• 8 Bloch J, Vernet O, Aubé M, Villemure JG. Non-obstructive hydrocephalus associated with intracranial schwannomas: Hyperproteinorrhachia as an etiopathological factor?. Acta Neurochir (Wien) 2003; 145: 73-78
• 9 Gardner WJ, Spitler DK, Whitten C. Increased intracranial pressure caused by increased protein content in the cerebrospinal fluid; an explanation of papilledema in certain cases of small intracranial and intraspinal tumors, and in the Guillain-Barre syndrome. N Engl J Med 1954; 250: 932-936
• 10 Steenerson RL, Payne N. Hydrocephalus in the patient with acoustic neuroma. Otolaryngol Head Neck Surg 1992; 107: 35-39
• 11 Rogg JM, Ahn SH, Tung GA, Reinert SE, Norén G. Prevalence of hydrocephalus in 157 patients with vestibular schwannoma. Neuroradiology 2005; 47: 344-351
• 12 Tanaka Y, Kobayashi S, Hongo K, Tada T, Sato A, Takasuna H. Clinical and neuroimaging characteristics of hydrocephalus associated with vestibular schwannoma. J Neurosurg 2003; 98: 1188-1193
• 13 Atlas MD, Perez de Tagle JR, Cook JA, Sheehy JP, Fagan PA. Evolution of the management of hydrocephalus associated with acoustic neuroma. Laryngoscope 1996; 106: 204-206
• 14 Briggs RJ, Shelton C, Kwartler JA, Hitselberger W. Management of hydrocephalus resulting from acoustic neuromas. Otolaryngol Head Neck Surg 1993; 109: 1020-1024
• 15 Sayk J. The cerebrospinal fluid in brain tumours. In: Vinken PJ, Bruyn GW. editors Handbook of Clinical Neurology: Tumours of the Brain and Skull. Vol. 16. North-Holland, Amsterdam: Elsievier; 1974. p 360-417
• 16 Brennan JW, Rowed DW, Nedzelski JM, Chen JM. Cerebrospinal fluid leak after acoustic neuroma surgery: Influence of tumor size and surgical approach on incidence and response to treatment. J Neurosurg 2001; 94: 217-223
• 17 Stieglitz LH, Wrede KH, Gharabaghi A, Gerganov VM, Samii A, Samii M. et al Factors affecting postoperative cerebrospinal fluid leaks after retrosigmoidal craniotomy for vestibular schwannomas. J Neurosurg 2009; 111: 874-883
• 18 Tonn JC, Schlake HP, Goldbrunner R, Milewski C, Helms J, Roosen K. Acoustic neuroma surgery as an interdisciplinary approach: A neurosurgical series of 508 patients. J Neurol Neurosurg Psychiatry 2000; 69: 161-166
• 19 Hoffman RA. Cerebrospinal fluid leak following acoustic neuroma removal. Laryngoscope 1994; 104: 40-58
• 20 Sughrue ME, Yang I, Aranda D, Rutkowski MJ, Fang S, Cheung SW. et al Beyond audiofacial morbidity after vestibular schwannoma surgery. J Neurosurg 2011; 114: 367-374
• 21 Sanna M, Taibah A, Russo A, Falcioni M, Agarwal M. Perioperative complications in acoustic neuroma (vestibular schwannoma) surgery. Otol Neurotol 2004; 25: 379-386