Treatment Outcome of Hydrocephalus Associated with Vestibular Schwannoma
10.3988/jcn.2021.17.3.455
- Author:
Dong-Won SHIN
1
;
Sang Woo SONG
;
SangJoon CHONG
;
Young-Hoon KIM
;
Young Hyun CHO
;
Seok Ho HONG
;
Jeong Hoon KIM
Author Information
1. Department of Neurosurgery, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
- Publication Type:ORIGINAL ARTICLE
- From:Journal of Clinical Neurology
2021;17(3):455-462
- CountryRepublic of Korea
- Language:English
-
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.
