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Risk factors and tumor response associated with hydrocephalus after gamma knife radiosurgery for vestibular schwannoma

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Abstract

Background

This study was designed to investigate the clinical characteristics and risk factors of hydrocephalus after gamma knife radiosurgery (GKRS) for vestibular schwannoma.

Methods

The authors retrospectively reviewed clinical and neuroimaging findings of 221 patients who underwent GKRS for newly diagnosed vestibular schwannoma. Mean patient age was 54.1 years (range 7–83 years), mean tumor volume was 3,010.4 mm3 (range 34.7 to 14,300 mm3), mean marginal dose was 12.5 Gy (range 11 to 15 Gy), and mean follow-up duration was 31.9 months (range 1 to 107.6 months).

Results

Surgical intervention for cerebrospinal fluid (CSF) diversion after GKRS was necessary in 11 (5 %) of the patients. Median time between GKRS and ventriculoperitoneal (VP) shunt placement was 15.5 months (range 1.8–37.8 months). These 11 patients showed female predominance (11 females) and mean tumor volume was significantly larger than in the other without hydrocephalus (6,509 vs. 2,726 mm3; p < 0.01). Decreases in tumor enhancement and swelling were observed in all 221 patients, and CSF protein was found to be elevated in five of nine patients with available data at the time of the shunt procedure. Hydrocephalic symptoms improved after VP shunt and tumor sizes further decreased at last follow-up in all patients.

Conclusions

Hydrocephalus after radiosurgery may co-occur with a temporary change of tumor volume after radiation treatment. Therefore, hydrocephalus should be kept in mind during the time of tumor volume transition. Furthermore, the authors suggest that frequent patient monitoring for hydrocephalus be maintained for up to 3–4 years after GKRS.

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Acknowledgments

This study was supported by a grant of the Korea Healthcare Technology R&D Project, Ministry for Health & Welfare Affairs, Republic of Korea. (A092255)

Conflicts of interest

None.

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Authors and Affiliations

  1. Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul, 135-710, Korea

    Seung Hoon Lee, Ho Jun Seol, Doo Sik Kong, Do-Hyun Nam, Kwan Park, Jong Hyun Kim & Jung-Il Lee

Authors
  1. Seung Hoon Lee
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  2. Ho Jun Seol
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  3. Doo Sik Kong
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  4. Do-Hyun Nam
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  5. Kwan Park
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  6. Jong Hyun Kim
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  7. Jung-Il Lee
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Corresponding author

Correspondence to Jung-Il Lee.

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Comment

For the first time, in this paper a vulnerable phase is identified for the development of hydrocephalus following gamma knife radiosurgery for acoustic neurinoma. Even though hydrocephalus following gamma knife radiosurgery for acoustic neurinoma is a rare complication, it is important to know the time period during which it may typically occur and follow patients for that potential complication accordingly.

Thomas Mindermann

Zurich, Switzerland

Seung Hoon Lee and Ho Jun Seol contributed equally to this work.

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Lee, S.H., Seol, H.J., Kong, D.S. et al. Risk factors and tumor response associated with hydrocephalus after gamma knife radiosurgery for vestibular schwannoma. Acta Neurochir 154, 1679–1684 (2012). https://doi.org/10.1007/s00701-012-1350-0

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  • DOI: https://doi.org/10.1007/s00701-012-1350-0

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