Treatment Outcome of Hydrocephalus Associated with Vestibular Schwannoma

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. 'I he 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.

Automated summary

This study evaluated the clinical factors associated with managing hydrocephalus in patients with vestibular schwannoma, finding that severe hydrocephalus, cystic tumors, and partial resection are predictive of treatment failure. Recommendations include attempting near-total tumor resection in patients with VS.