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J Neurol Surg B Skull Base 2013; 74(02): 068-074
DOI: 10.1055/s-0033-1333621
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Communicating Hydrocephalus and Vestibular Schwannomas: Etiology, Treatment, and Long-Term Follow-Up

Qasim Al Hinai
1   Department of Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montréal, Québec, Canada
,
Anthony Zeitouni
2   Department of Otolaryngology, McGill University, Montréal, Québec, Canada
,
Denis Sirhan
1   Department of Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montréal, Québec, Canada
,
David Sinclair
1   Department of Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montréal, Québec, Canada
,
Denis Melancon
3   Department of Diagnostic Neuroradiology, Montreal Neurological Institute and Hospital, McGill University, Montréal, Québec, Canada
,
John Richardson
4   Department of Neuropathology, Montreal Neurological Institute and Hospital, McGill University, Montréal, Québec, Canada
,
Richard Leblanc
1   Department of Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montréal, Québec, Canada
› Author Affiliations
Further Information

Publication History

01 September 2012

24 October 2012

Publication Date:
07 February 2013 (online)

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Abstract

Background Large vestibular schwannomas (VSs) can cause hydrocephalus by obstructing the fourth ventricle. Little is known about the communicating hydrocephalus that is seen with a smaller VS.

Methods The clinicopathological findings and follow up of three patients with communicating hydrocephalus associated with a small VS are presented.

Results Four patients aged 40 to 66 years (mean: 57.7) presented with ataxia, dementia, and urinary incontinence. The VS were 2.0 to 2.4 cm. The cerebrospinal fluid (CSF) protein was elevated in three patients in whom it was measured (1.7 to 6 times normal). The VS was resected in two patients. All of the patients required ventriculoperitoneal shunting (VPS). All of the patients were asymptomatic or improved at follow-up at 9 months to 13 years.

Conclusion Communicating hydrocephalus associated with a VS can occur in younger patients than was previously thought. An elevated CSF protein appears to be important, but other factors may be involved. A shunting procedure is often required to relieve the symptoms of hydrocephalus even if the tumor is resected. Possible etiological causes of communicating hydrocephalus in patients with a small VS are discussed.

Keywords

vestibular schwannoma - communicating hydrocephalus
 

  • References

  • 1 Adams RD, Fisher CM, Hakim S, Ojemann RG, Sweet WH. Symptomatic occult hydrocephalus with “normal” cerebrospinal pressures: a treatable syndrome. N Engl J Med 1965; 273: 117-126
    CrossrefPubMedGoogle Scholar
  • 2 Bloch J, Vernet O, Aubé M, Villemure J-G. Non-obstructive hydrocephalus associated with intracranial schwannomas: hyperproteinorrhachia as an etiopathological factor?. Acta Neurochir (Wien) 2003; 145: 73-78
    CrossrefPubMedGoogle Scholar
  • 3 Kühne D, Schmidt H, Janzen RW, Lachenmayer L. [Communicating hydrocephalus due to acustic neurinoma (author's transl)]. Radiologe 1977; 17: 478-481
    PubMedGoogle Scholar
  • 4 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
    CrossrefPubMedGoogle Scholar
  • 5 Rogg JM, Ahn SH, Tung GA, Reinert SE, Norén G. Prevalence of hydrocephalus in 157 patients with vestibular schwannoma. Neuroradiology 2005; 47: 344-351
    CrossrefPubMedGoogle Scholar
  • 6 Atlas MD, Perez de Tagle JRV, Cook JA, Sheehy JP, Fagan PA. Evolution of the management of hydrocephalus associated with acoustic neuroma. Laryngoscope 1996; 106 (2 Pt 1) 204-206
    CrossrefPubMedGoogle Scholar
  • 7 Briggs RJ, Shelton C, Kwartler JA, Hitselberger W. Management of hydrocephalus resulting from acoustic neuromas. Otolaryngol Head Neck Surg 1993; 109: 1020-1024
    CrossrefPubMedGoogle Scholar
  • 8 Fukuda M, Oishi M, Kawaguchi T , et al. Etiopathological factors related to hydrocephalus associated with vestibular schwannoma. Neurosurgery 2007; 61: 1186-1192 , discussion 1192–1193
    Google Scholar
  • 9 Gerganov VM, Pirayesh A, Nouri M , et al. Hydrocephalus associated with vestibular schwannomas: management options and factors predicting the outcome. J Neurosurg 2011; 114: 1209-1215
    Google Scholar
  • 10 Hoffman RA. Cerebrospinal fluid leak following acoustic neuroma removal. Laryngoscope 1994; 104 (1 Pt 1) 40-58
    PubMedGoogle Scholar
  • 11 Pirouzmand F, Tator CH, Rutka J. Management of hydrocephalus associated with vestibular schwannoma and other cerebellopontine angle tumors. Neurosurgery 2001; 48: 1246-1253 , discussion 1253–1254
    PubMedGoogle Scholar
  • 12 Steenerson RL, Payne N. Hydrocephalus in the patient with acoustic neuroma. Otolaryngol Head Neck Surg 1992; 107: 35-39
    CrossrefPubMedGoogle Scholar
  • 13 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
    CrossrefPubMedGoogle Scholar
  • 14 Nassar SI, Correll JW. Subarachnoid hemorrhage due to spinal cord tumors. Neurology 1968; 18 (1 Pt 1) 87-94
    PubMedGoogle Scholar
  • 15 Sawamura Y, Shirato H, Sakamoto T , et al. Management of vestibular schwannoma by fractionated stereotactic radiotherapy and associated cerebrospinal fluid malabsorption. J Neurosurg 2003; 99: 685-692
    CrossrefPubMedGoogle Scholar
  • 16 Ayer JB, Solomoin HC. Examination of the cerebrospinal fluid from different loci. In: Dana CL, Riley HA, Davis TK, , et al, eds. The Human Cerebrospinal Fluid. Association for Research in Nervous & Mental Diseases. Volume IV. New York: Paul B. Hoeber; 1926: 84-99
    Google Scholar
  • 17 Weisner B, Bernhardt W. Protein fractions of lumbar, cisternal, and ventricular cerebrospinal fluid. Separate areas of reference. J Neurol Sci 1978; 37: 205-214
    CrossrefPubMedGoogle Scholar
  • 18 Bamford CR, Labadie EL. Reversal of dementia in normotensive hydrocephalus after removal of a cauda equina tumor. Case report. J Neurosurg 1976; 45: 104-107
    PubMedGoogle Scholar
  • 19 Spurling RG, Maddock CL. The study of the cerebrospinal fluid in cases of brain tumor. In: Dana CL, Riley HA, Davis TK, , et al, eds. The Human Cerebrospinal Fluid. Association for Research in Nervous & Mental Diseases. Volume IV. New York: Paul B. Hoeber; 1926: 418-427
    Google Scholar
  • 20 Edwards CH, Paterson JH. A review of the symptoms and signs of acoustic neurofibromata. Brain 1951; 74: 144-190
    CrossrefPubMedGoogle Scholar
  • 21 Sayk J. The cerebrospinal fluid in brain tumours. In: Vinken PJ, Bruyn GW, , eds. Handbook of Clinical Neurology: Tumours of the Brain and Skull. Vol 16. Amsterdam: North-Holland Publishing Company; 1974: 360-417
    Google Scholar
  • 22 Wada K, Nawashiro H, Shimizu A, Shima K. MRI analysis of hydrocephalus associated with acoustic neurinoma. Acta Neurochir Suppl (Wien) 2003; 86 (Suppl. 86) 549-551
    PubMedGoogle Scholar
  • 23 Motohashi O, Suzuki M, Shida N , et al. Subarachnoid haemorrhage induced proliferation of leptomeningeal cells and deposition of extracellular matrices in the arachnoid granulations and subarachnoid space. Immunhistochemical study. Acta Neurochir (Wien) 1995; 136: 88-91
    CrossrefPubMedGoogle Scholar
  • 24 Becker DP. Acoustics and hydrocephalus. Editorial J Neurosurg 2011; 114: 1207-1208 , discussion 1208
    PubMedGoogle Scholar