J Clin Neurol.  2021 Jul;17(3):455-462. 10.3988/jcn.2021.17.3.455.

Treatment Outcome of Hydrocephalus Associated with Vestibular Schwannoma

• Shin DW
• Song SW
• Chong S
• Kim YH
• Cho YH
• Hong SH
• Kim JH

• KMID: 2516742
• DOI: http://doi.org/10.3988/jcn.2021.17.3.455

Abstract

Background and Purpose
Managing hydrocephalus in patients with vestibular schwannoma (VS) is controversial. We evaluated the clinical factors associated with hydrocephalus.
Methods
Between 2000 and 2019, 562 patients with VS were treated at our institute. We applied endoscopic third ventriculostomy (ETV), external ventricular drainage (EVD), and ventriculoperitoneal (VP) shunts to patients with hydrocephalus. The relationships of patient, tumor, and surgical variables with the hydrocephalus outcome were assessed.
Results
Preoperative hydrocephalus (Evans ratio ≥0.3) was present in 128 patients. Six patients who received a preresectional VP shunt were excluded after analyzing the hydrocephalus outcome. Seven of the remaining 122 patients had severe hydrocephalus (Evans ratio ≥0.4). Primary tumor resection, VP shunting, ETV, and EVD were performed in 60, 6, 57, and 5 patients, respectively. The hydrocephalus treatment failure rate was highest in the EVD group. Persistent hydrocephalus was present in five (8%) and seven (12%) patients in the primary resection and ETV groups, respectively. Multivariate analysis revealed that severe hydrocephalus, the cystic tumor, and the extent of resection (subtotal resection or partial resection) were associated with hydrocephalus treatment failure.
Conclusions
Larger ventricles and a higher cystic portion are predictive of persistent hydrocephalus. We recommend attempting near-total tumor resection in patients with VS.

Keyword

hydrocephalus; neuroma; acoustic; ventriculostomy; schwannoma; endoscope