Abstract
Background
Cerebrospinal fluid (CSF) protein levels are known to increase in patients with vestibular schwannomas (VS) with concomitant hydrocephalus, however the only information available on perioperative changes in CSF in these patients comes from case reports. Here, we investigated the relation between CSF protein and hydrocephalus in a large series of patients undergoing resection of VS.
Method
We classified 376 patients undergoing resection for VS at our institute into two groups, namely VS and no hydrocephalus (control, n = 319) and VS with concomitant hydrocephalus (n = 57), and compared clinical parameters. Among the 57 patients diagnosed with hydrocephalus, hydrocephalus status was examined by lumbar puncture in 20 patients with communicative hydrocephalus, and pre- and postoperative scores in CSF properties were compared.
Results
Patients in the hydrocephalus group were significantly older than those in the control group (mean, 55.8 vs. 43.8 years), and had a longer disease duration (median, 76 vs. 12 months), larger tumors (median, 15.6 vs. 5.5 ml), and a higher protein concentration in CSF (median, 147.3 vs. 65.1 mg/dl). Perioperative CSF samples of hydrocephalus patients showed a significantly decrease in cerebrospinal pressure after tumor removal (median, -75mmH2O), followed by a decrease in CSF protein (median, -74.5 mg/dl). No patients required the placement of a shunt.
Conclusions
Extended disease duration and elevated CSF protein secondary to the presence of a tumor contribute to the occurrence of hydrocephalus. Primary maximal tumor removal for VS with coexisting hydrocephalus avoids an unnecessary shunt.
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References
Atlas MD, Perez de Tagle JR, Cook JA, Sheehy JP, Fagan PA (1996) Evolution of the management of hydrocephalus associated with acoustic neuroma. Laryngoscope 106:204–206
Bamford CR, Labadie EL (1967) Reversal of dementia in normotensive hydrocephalus after removal of a cauda equina tumor. Case report. J Neurosurg 45:104–107
Bloch J, Vernet O, Aube M, Villemure JG (2003) Non-obstructive hydrocephalus associated with intracranial schwannomas: hyperproteinorrhachia as an etiopathological factor? Acta Neurochir (Wien) 145:73–78
Borgesen SE, Sorensen SC, Olesen J, Gjerris F (1997) Spinal tumours associated with increased intracranial pressure. Report of two cases and a discussion on the pathophysiology. Acta Neurol Scand 56:263–268
Briggs RJ, Shelton C, Kwartler JA, Hitselberger W (1993) Management of hydrocephalus resulting from acoustic neuromas. Otolaryngol Head Neck Surg 109:1020–1024
Cauley KA, Ratkovits B, Braff SP, Linnell G (2009) Communicating hydrocephalus after gamma knife radiosurgery for vestibular schwannoma: an MR imaging study. AJNR Am J Neuroradiol 30:992–994
Fukuda M, Oishi M, Kawaguchi T, Watanabe M, Takao T, Tanaka R, Fujii Y (2007) Etiopathological factors related to hydrocephalus associated with vestibular schwannoma. Neurosurgery 61:1186–1192, discussion 1192–1183
Gerganov VM, Pirayesh A, Nouri M, Hore N, Luedemann WO, Oi S, Samii A, Samii M (2011) Hydrocephalus associated with vestibular schwannomas: management options and factors predicting the outcome. J Neurosurg 114:1209–1215
Greitz D (2004) Radiological assessment of hydrocephalus: new theories and implications for therapy. Neurosurg Rev 27:145–165, discussion 166–167
Hasegawa H, Ma T, Skach W, Matthay MA, Verkman AS (1994) Molecular cloning of a mercurial-insensitive water channel expressed in selected water-transporting tissues. J Biol Chem 269:5497–5500
Jeon CJ, Kong DS, Nam DH, Lee JI, Park K, Kim JH (2010) Communicating hydrocephalus associated with surgery or radiosurgery for vestibular schwannoma. J Clin Neurosci 17:862–864
Johnston M, Papaiconomou C (2002) Cerebrospinal fluid transport, a lymphatic perspective. News Physiol Sci 17:227–230
Kanayama S, Kohno M, Okamura K, Yoshino M, Segawa H, Saito I, Sano K (2006) Case of hydrocephalus associated with vestibular schwannoma, treated by tumor removal. No Shinkei Geka 34:391–395 (Jpn)
Krishnamurthy S, Li J, Schultz L, McAllister JP 2nd (2009) Intraventricular infusion of hyperosmolar dextran induces hydrocephalus: a novel animal model of hydrocephalus. Cerebrospinal Fluid Res 6:16
Mohammed TA, Ahuja MS, Ju SS, Thomas J (2010) Normal pressure hydrocephalus after gamma knife radiosurgery for vestibular schwannoma. J Postgrad Med 56:213–215
Morandi X, Amlashi SF, Riffaud L (2006) A dynamic theory for hydrocephalus revealing benign intraspinal tumours: tumoural obstruction of the spinal subarachnoid space reduces total CSF compartment compliance. Med Hypotheses 67:79–81
Nishida K, Ueda S, Matsumoto K, Kusaka K, Takeuchi R (1990) Cauda equina neurinoma associated with normal pressure hydrocephalus–case report. Neurol Med Chir (Tokyo) 30:258–262
Oi S, Di Rocco C (2006) Proposal of “evolution theory in cerebrospinal fluid dynamics” and minor pathway hydrocephalus in developing immature brain. Childs Nerv Syst 22:662–669
Pirouzmand F, Tator CH, Rutka J (2001) Management of hydrocephalus associated with vestibular schwannoma and other cerebellopontine angle tumors. Neurosurgery 48:1246–1253, discussion 1253–1244
Roche PH, Khalil M, Soumare O, Régis J (2008) Hydrocephalus and vestibular schwannomas: considerations about the impact of gamma knife radiosurgery. Prog Neurol Surg 21:200–206
Roche PH, Ribeiro T, Soumare O, Robitail S, Pellet W, Régis J (2004) Hydrocephalus and vestibular schwannomas treated by gamma knife radiosurgery. Neurochirurgie 50:345–349 (French)
Rogg JM, Ahn SH, Tung GA, Reinert SE, Noren G (2005) Prevalence of hydrocephalus in 157 patients with vestibular schwannoma. Neuroradiology 47:344–351
Sobue K, Yamamoto N, Yoneda K, Fujita K, Miura Y, Asai K, Tsuda T, Katsuya H, Kato T (1999) Molecular cloning of two bovine aquaporin-4 cDNA isoforms and their expression in brain endothelial cells. Biochim Biophys Acta 1489:393–398
Sun H, Tian H (2011) Intraspinal tumors accompanied by hydrocephalus: case report, systematic review, and discussion of treatment strategy. Neurologist 17:342–345
Tanaka Y, Kobayashi S, Hongo K, Tada T, Sato A, Takasuna H (2003) Clinical and neuroimaging characteristics of hydrocephalus associated with vestibular schwannoma. J Neurosurg 98:1188–1193
Venero JL, Vizuete ML, Machado A, Cano J (2001) Aquaporins in the central nervous system. Prog Neurobiol 63:321–336
Wada K, Nawashiro H, Shimizu A, Shima K (2003) MRI analysis of hydrocephalus associated with acoustic neurinoma. Acta Neurochir Suppl 86:549–551
Acknowledgments
The authors thank the neurosurgeons, medical engineers, and medical technologists at Tokyo Metropolitan Police Hospital for their assistance in the surgeries for vestibular schwannomas.
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The authors declare that they have no conflicts of interest.
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Miyakoshi, A., Kohno, M., Nagata, O. et al. Hydrocephalus associated with vestibular schwannomas: perioperative changes in cerebrospinal fluid. Acta Neurochir 155, 1271–1276 (2013). https://doi.org/10.1007/s00701-013-1742-9
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DOI: https://doi.org/10.1007/s00701-013-1742-9