Eticipathological factors related to hydrocephalus associated with vestibular schwannoma
Eticipathological factors related to hydrocephalus associated with vestibular schwannoma
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DOI：
10.1227/01.neu.0000306096.61012.22
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发表时间：
2007-12-01
期刊：
影响因子：
4.8
通讯作者：
Fujii, Yukihiko
中科院分区：
文献类型：
--
作者：
Fukuda, Masafumi;Oishi, Makoto;Fujii, Yukihiko
目的：我们回顾性分析各种临床因素，以确定这些因素是否在病因病理上与前庭神经鞘瘤患者脑积水的发生相关。
方法：本研究中有68例患者（29例男性，39例女性）接受了前庭神经鞘瘤切除术。手术时年龄为19 - 76岁（平均年龄51.4岁）。小脑桥脑角池内肿瘤的最大直径为0（局限于内听道内）至56毫米（平均32.0 ± 12.9毫米）。所有患者术中均测量了小脑延髓池的脑脊液（CSF）蛋白浓度。
结果：68例患者中有16例（23.5%）有脑积水的影像学证据。对各种因素的单因素分析显示，肿瘤大小和脑脊液蛋白浓度均与脑积水的发生呈正相关（分别为P < 0.05和P < 0.01）。然而，在多元逻辑回归分析中，只有脑脊液蛋白浓度对脑积水的发生有预测作用（P = 0.022）。与小肿瘤（< 40毫米）患者相比，大肿瘤（≥40毫米）患者的脑脊液蛋白浓度有升高的趋势（P = 0.06）。
结论：小脑延髓池脑脊液中高蛋白浓度是导致前庭神经鞘瘤相关脑积水的最重要因素之一。除了肿瘤切除外，判断脑积水是否需要进一步治疗是很重要的，特别是对于交通性脑积水患者。
OBJECTIVE: We retrospectively analyzed various clinical factors to determine whether or not these factors are etiopathologically related to the development of hydrocephalus in patients with vestibular schwannomas.METHODS: There were 68 patients (29 men, 39 women) in this study who underwent resection of a vestibular schwannoma. The age at the time of surgery ranged from 19 to 76 years (mean age, 51.4 yr). The maximum diameter of the tumor in the cerebello-pontine cistern ranged from 0 (localized within the internal auditory canal) to 56 mm (mean, 32.0 +/- 12.9 mm). Cerebrospinal fluid (CSF) protein concentration in the cere-bellomedullary cistern was measured intraoperatively in all patients.RESULTS: Sixteen (23.5%) of the 68 patients exhibited radiographic evidence of hydrocephalus. Univariate analysis of various factors revealed that both tumor size and CSF protein concentration Were positively related to development of hydrocephalus (P < 0.05 and P < 0.01, respectively). However, in multiple logistic regression analysis, only the CSF protein concentration was predictive for development of hydrocephalus (P = 0.022). There was a trend toward increased CSF protein concentration in patients with a large tumor (>= 40 mm) compared with those with a small tumor (< 40 mm) (P = 0.06).CONCLUSION: A high CSF protein concentration in fluid from the cerebellomedullary cistern is one of the most important factors contributing to hydrocephalus associated with vestibular schwannoma. It is important to judge whether or not any further treatment is required for hydrocephalus, in addition to tumor resection, especially in patients with communicating hydrocephalus.