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Hydrocephalus Associated with Large Vestibular Schwannoma: Management Options and Factors Predicting Requirement of Cerebrospinal Fluid Diversion after Primary Surgery

OBJECTIVE: Obstructive hydrocephalus (HCP) related to vestibular schwannoma occurs in large tumors compressing the fourth ventricle. Symptoms related to HCP are expected to alleviate after resection of the tumor and decompression of the cerebrospinal fluid (CSF) pathways. However, some patients may...

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Autores principales: Prabhuraj, A. R., Sadashiva, Nishanth, Kumar, Santhosh, Shukla, Dhaval, Bhat, Dhananjaya, Devi, Bhagavatula Indira, Somanna, Sampath
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Medknow Publications & Media Pvt Ltd 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5602256/
https://www.ncbi.nlm.nih.gov/pubmed/28936068
http://dx.doi.org/10.4103/jnrp.jnrp_264_17
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author Prabhuraj, A. R.
Sadashiva, Nishanth
Kumar, Santhosh
Shukla, Dhaval
Bhat, Dhananjaya
Devi, Bhagavatula Indira
Somanna, Sampath
author_facet Prabhuraj, A. R.
Sadashiva, Nishanth
Kumar, Santhosh
Shukla, Dhaval
Bhat, Dhananjaya
Devi, Bhagavatula Indira
Somanna, Sampath
author_sort Prabhuraj, A. R.
collection PubMed
description OBJECTIVE: Obstructive hydrocephalus (HCP) related to vestibular schwannoma occurs in large tumors compressing the fourth ventricle. Symptoms related to HCP are expected to alleviate after resection of the tumor and decompression of the cerebrospinal fluid (CSF) pathways. However, some patients may require permanent cerebrospinal diversion even after surgery due to persistent HCP. In this study, the authors try to find out the factors associated with the requirement of CSF diversion after vestibular schwannoma surgery in cases of persistent HCP. MATERIALS AND METHODS: This was a retrospective study involving 193 cases of vestibular schwannoma operated between 2010 and 2013 in our institute. Cases that underwent ventriculoperitoneal (VP) shunts before surgery were compared to cases which were operated directly. In cases where vestibular schwannomas were operated without prior VP shunts, factors which were associated with persistent postoperative HCP were analyzed. RESULTS: Comparing the group who underwent direct surgery to the group who underwent VP shunt before definitive vestibular schwannoma surgery, the facial nerve preservation rates and surgical morbidity rates were comparable. In cases who underwent direct surgery, 10 out of 75 patients required postoperative permanent CSF diversion. Older age, male gender, duration of symptoms, larger tumor size, solid lesions, severe HCP, and clinical features of HCP were associated with postoperative requirement of CSF diversion but were not statistically significant. The most significant factor that correlated with the need for additional HCP treatment was the presence of postoperative hematoma of volume >10cc. CONCLUSIONS: Primary tumor removal is the optimal treatment for vestibular schwannoma associated with HCP. Postoperative hematoma may warrant close observation as these patients are at an increased risk of persistence of HCP.
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spelling pubmed-56022562017-09-21 Hydrocephalus Associated with Large Vestibular Schwannoma: Management Options and Factors Predicting Requirement of Cerebrospinal Fluid Diversion after Primary Surgery Prabhuraj, A. R. Sadashiva, Nishanth Kumar, Santhosh Shukla, Dhaval Bhat, Dhananjaya Devi, Bhagavatula Indira Somanna, Sampath J Neurosci Rural Pract Original Article OBJECTIVE: Obstructive hydrocephalus (HCP) related to vestibular schwannoma occurs in large tumors compressing the fourth ventricle. Symptoms related to HCP are expected to alleviate after resection of the tumor and decompression of the cerebrospinal fluid (CSF) pathways. However, some patients may require permanent cerebrospinal diversion even after surgery due to persistent HCP. In this study, the authors try to find out the factors associated with the requirement of CSF diversion after vestibular schwannoma surgery in cases of persistent HCP. MATERIALS AND METHODS: This was a retrospective study involving 193 cases of vestibular schwannoma operated between 2010 and 2013 in our institute. Cases that underwent ventriculoperitoneal (VP) shunts before surgery were compared to cases which were operated directly. In cases where vestibular schwannomas were operated without prior VP shunts, factors which were associated with persistent postoperative HCP were analyzed. RESULTS: Comparing the group who underwent direct surgery to the group who underwent VP shunt before definitive vestibular schwannoma surgery, the facial nerve preservation rates and surgical morbidity rates were comparable. In cases who underwent direct surgery, 10 out of 75 patients required postoperative permanent CSF diversion. Older age, male gender, duration of symptoms, larger tumor size, solid lesions, severe HCP, and clinical features of HCP were associated with postoperative requirement of CSF diversion but were not statistically significant. The most significant factor that correlated with the need for additional HCP treatment was the presence of postoperative hematoma of volume >10cc. CONCLUSIONS: Primary tumor removal is the optimal treatment for vestibular schwannoma associated with HCP. Postoperative hematoma may warrant close observation as these patients are at an increased risk of persistence of HCP. Medknow Publications & Media Pvt Ltd 2017-08 /pmc/articles/PMC5602256/ /pubmed/28936068 http://dx.doi.org/10.4103/jnrp.jnrp_264_17 Text en Copyright: © 2017 Journal of Neurosciences in Rural Practice http://creativecommons.org/licenses/by-nc-sa/3.0 This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
spellingShingle Original Article
Prabhuraj, A. R.
Sadashiva, Nishanth
Kumar, Santhosh
Shukla, Dhaval
Bhat, Dhananjaya
Devi, Bhagavatula Indira
Somanna, Sampath
Hydrocephalus Associated with Large Vestibular Schwannoma: Management Options and Factors Predicting Requirement of Cerebrospinal Fluid Diversion after Primary Surgery
title Hydrocephalus Associated with Large Vestibular Schwannoma: Management Options and Factors Predicting Requirement of Cerebrospinal Fluid Diversion after Primary Surgery
title_full Hydrocephalus Associated with Large Vestibular Schwannoma: Management Options and Factors Predicting Requirement of Cerebrospinal Fluid Diversion after Primary Surgery
title_fullStr Hydrocephalus Associated with Large Vestibular Schwannoma: Management Options and Factors Predicting Requirement of Cerebrospinal Fluid Diversion after Primary Surgery
title_full_unstemmed Hydrocephalus Associated with Large Vestibular Schwannoma: Management Options and Factors Predicting Requirement of Cerebrospinal Fluid Diversion after Primary Surgery
title_short Hydrocephalus Associated with Large Vestibular Schwannoma: Management Options and Factors Predicting Requirement of Cerebrospinal Fluid Diversion after Primary Surgery
title_sort hydrocephalus associated with large vestibular schwannoma: management options and factors predicting requirement of cerebrospinal fluid diversion after primary surgery
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5602256/
https://www.ncbi.nlm.nih.gov/pubmed/28936068
http://dx.doi.org/10.4103/jnrp.jnrp_264_17
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