Vestibular Schwannoma, Radiosurgery and Hydrocephalus

  • Keith A. Cauley
Part of the Tumors of the Central Nervous System book series (TCNS, volume 7)


Hydrocephalus is an uncommon and controversial complication of radiosurgery for vestibular schwannoma (VS). The controversy arises as hydrocephalus can also be associated with untreated vestibular schwannoma. Nevertheless, retrospective review of radiosurgical cases suggest that in a minority of cases of treated vestibular schwannomas, radiosurgery appears to cause or significantly accelerate subsequent hydrocephalus. This chapter discusses the evidence for this claim, and reviews the frequency of this complication, correlating variables, predisposing factors, proposed mechanisms, and patient management options.


Gamma Knife Vestibular Schwannoma Obstructive Hydrocephalus Gamma Knife Radiosurgery Radiosurgical Treatment 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. Abram S, Rosenblatt P, Holcomb S (2007) Stereotactic radiation techniques in the treatment of acoustic schwannomas. Otolaryngol Clin North Am 40:571–588PubMedCrossRefGoogle Scholar
  2. Andrews DW, Suarez O, Goldman HW, Downes MB, Bednarz G, Corn BW, Werner-Wasik M, Rosenstock J, Curran WJ Jr (2001) Stereotactic radiosurgery and fractionated stereotactic radiotherapy for the treatment of acoustic schwannomas: comparative observations of 125 patients treated at one institution. Int J Radiat Oncol Biol Phys 50:1265–1278PubMedCrossRefGoogle Scholar
  3. Atlas MD, Perez de Tagle JR, Cook JA, Sheehy JP, Fagan PA (1996) Evolution of the management of hydrocephalus associated with acoustic neuroma. Laryngoscope 106:204–206PubMedCrossRefGoogle Scholar
  4. Awaji M, Okamoto K, Nishiyama K (2007) Magnetic resonance cisternography for preoperative evaluation of arachnoid cysts. Neuroradiology 49:721–726PubMedCrossRefGoogle Scholar
  5. Battista RA (2009) Gamma knife radiosurgery for vestibular schwannoma. Otolaryngol Clin North Am 42:635–654PubMedCrossRefGoogle Scholar
  6. Bradley WG Jr, Scalzo D, Queralt J, Nitz WN, Atkinson DJ, Wong P (1996) Normal-pressure hydrocephalus: evaluation with cerebrospinal fluid flow measurements at MR imaging. Radiology 198:523–529PubMedGoogle Scholar
  7. Briggs RJ, Shelton C, Kwartler JA, Hitselberger W (1993) Management of hydrocephalus resulting from acoustic neuromas. Otolaryngol Head Neck Surg 109:1020–1024PubMedGoogle Scholar
  8. 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 30:992–994PubMedCrossRefGoogle Scholar
  9. Davson H, Hollingsworth G, Segal MB (1970) The mechanism of drainage of the cerebrospinal fluid. Brain 93:665–678PubMedCrossRefGoogle Scholar
  10. Gammal TE, Allen MB Jr, Brooks BS, Mark EK (1987) MR evaluation of hydrocephalus. AJR Am J Roentgenol 149:807–813PubMedGoogle Scholar
  11. Gardner WJ, Spitler DK, Whitten C (1954) 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 250:932–936PubMedCrossRefGoogle Scholar
  12. Hasegawa T, Kida Y, Yoshimoto M, Koike J, Goto K (2006) Evaluation of tumor expansion after stereotactic radiosurgery in patients harboring vestibular schwannomas. Neurosurgery 58:1119–1128PubMedCrossRefGoogle Scholar
  13. Hayhurst C, Javadpour M, O’Brien DF, Mallucci CL (2006) The role of endoscopic third ventriculostomy in the management of hydrocephalus associated with cerebellopontine angle tumours. Acta Neurochir (Wien) 148:1147–1150CrossRefGoogle Scholar
  14. Jallo GI, Kothbauer KF, Abbott IR (2005) Endoscopic third ventriculostomy. Neurosurg Focus 19:1–4Google Scholar
  15. Karpinos M, Teh BS, Zeck O, Carpenter LS, Phan C, Mai WY, Lu HH, Chiu JK, Butler EB, Gormley WB, Woo SY (2002) Treatment of acoustic neuroma: stereotactic radiosurgery vs. microsurgery. Int J Radiat Oncol Biol Phys 54:1410–1421PubMedCrossRefGoogle Scholar
  16. Lin YC, Wang CC, Wai YY, Wan YL, Ng SH, Chen YL, Liu HL, Wang JJ (2010) Significant temporal evolution of diffusion anisotropy for evaluating early response to radiosurgery in patients with vestibular schwannoma: findings from functional diffusion maps. AJNR Am J Neuroradiol 31:269–274PubMedCrossRefGoogle Scholar
  17. Linskey ME, Lunsford LD, Flickinger JC, Kondziolka D (1992) Stereotactic radiosurgery for acoustic tumors. Neurosurg Clin N Am 3:191–205PubMedGoogle Scholar
  18. Lunsford LD, Linskey ME (1992) Stereotactic radiosurgery in the treatment of patients with acoustic tumors. Otolaryngol Clin North Am 25:471–491PubMedGoogle Scholar
  19. Meijer OW, Weijmans EJ, Knol DL, Slotman BJ, Barkhof F, Vandertop WP, Castelijns JA (2008) Tumor-volume changes after radiosurgery for vestibular schwannoma: implications for follow-up MR imaging protocol. AJNR Am J Neuroradiol 29:906–910PubMedCrossRefGoogle Scholar
  20. Myrseth E, Moller P, Pedersen PH, Vassbotn FS, Wentzel-Larsen T, Lund-Johansen M (2005) Vestibular schwannomas: clinical results and quality of life after microsurgery or gamma knife radiosurgery. Neurosurgery 56:927–935PubMedGoogle Scholar
  21. Myrseth E, Pedersen PH, Moller P, Lund-Johansen M (2007) Treatment of vestibular schwannomas. Why, when, and how? Acta Neurochir (Wien) 149:647–660CrossRefGoogle Scholar
  22. Noren G (1998) Long-term complications following gamma knife radiosurgery of vestibular schwannomas. Stereotact Funct Neurosurg 70(Suppl 1):65–73PubMedGoogle Scholar
  23. Noren G, Arndt J, Hindmarsh T (1983) Stereotactic radiosurgery in cases of acoustic neurinoma: further experiences. Neurosurgery 13:12–22PubMedCrossRefGoogle Scholar
  24. Pirouzmand F, Tator CH, Rutka J (2001) Management of hydrocephalus associated with vestibular schwannoma and other cerebellopontine angle tumors. Neurosurgery 48:1246–1253PubMedGoogle Scholar
  25. Pollock BE, Lunsford LD, Kondziolka D, Flickinger JC, Bissonette DJ, Kelsey SF, Jannetta PJ (1995) Outcome analysis of acoustic neuroma management: a comparison of microsurgery and stereotactic radiosurgery. Neurosurgery 36:215–226PubMedCrossRefGoogle Scholar
  26. Regis J, Roche PH, Thomassin JM (2008) Introduction. The evolution of the surgical management of vestibular schwannomas. Prog Neurol Surg 21:1–5PubMedCrossRefGoogle Scholar
  27. Roche PH, Khalil M, Soumare O, Regis J (2008) Hydrocephalus and vestibular schwannomas: considerations about the impact of gamma knife radiosurgery. Prog Neurol Surg 21:200–206PubMedCrossRefGoogle Scholar
  28. Rogg JM, Ahn SH, Tung GA, Reinert SE, Noren G (2005) Prevalence of hydrocephalus in 157 patients with vestibular schwannoma. Neuroradiology 47:344–351PubMedCrossRefGoogle Scholar
  29. Sawamura Y, Shirato H, Sakamoto T, Aoyama H, Suzuki K, Onimaru R, Isu T, Fukuda S, Miyasaka K (2003) Management of vestibular schwannoma by fractionated stereotactic radiotherapy and associated cerebrospinal fluid malabsorption. J Neurosurg 99:685–692PubMedCrossRefGoogle Scholar
  30. Sayk J (1974) The cerebrospinal fluid in brain tumors. In: Vinken PJ, Bruyn GW (eds) Handbook of clinical neurology: tumors of the brain and skull. North-Holland, Amsterdam, pp 360–417Google Scholar
  31. Sener RN (2003) Diffusion magnetic resonance imaging of solid vestibular schwannomas. J Comput Assist Tomogr 27:249–252PubMedCrossRefGoogle Scholar
  32. Spiegelmann R, Lidar Z, Gofman J, Alezra D, Hadani M, Pfeffer R (2001) Linear accelerator radiosurgery for vestibular schwannoma. J Neurosurg 94:7–13PubMedCrossRefGoogle Scholar
  33. Steenerson RL, Payne N (1992) Hydrocephalus in the patient with acoustic neuroma. Otolaryngol Head Neck Surg 107:35–39PubMedGoogle Scholar
  34. 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 98:1188–1193PubMedCrossRefGoogle Scholar
  35. Thomsen J, Tos M, Borgesen SE (1990) Gamma knife: hydrocephalus as a complication of stereotactic radiosurgical treatment of an acoustic neuroma. Am J Otol 11:330–333PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2012

Authors and Affiliations

  1. 1.University of Massachusetts Medical CenterWorcesterUSA

Personalised recommendations