Hydrocephalus Associated with Large Vestibular Schwannoma: Management Options and Factors Predicting Requirement of Cerebrospinal Fluid Diversion after Primary Surgery.
Hydrocephalus Associated with Large Vestibular Schwannoma: Management Options and Factors Predicting Requirement of Cerebrospinal Fluid Diversion after Primary Surgery.
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DOI：
10.4103/jnrp.jnrp_264_17
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发表时间：
2017-08
影响因子：
1.4
通讯作者：
Somanna S
中科院分区：
文献类型：
--
作者：
Prabhuraj AR;Sadashiva N;Kumar S;Shukla D;Bhat D;Devi BI;Somanna S
与前庭神经鞘瘤相关的梗阻性脑积水(HCP)发生在压迫第四脑室的大肿瘤中。与HCP相关的症状在肿瘤切除和脑脊液(CSF)途径减压后有望缓解。然而，由于持续的HCP，一些患者即使在手术后也可能需要永久性的脑脊液分流。在这项研究中，作者试图找出与持续性HCP患者前庭神经鞘瘤术后脑脊液分流要求相关的因素。本文对我所2010-2013年间手术治疗的193例前庭神经鞘瘤进行了回顾性研究。将术前接受脑室-腹膜分流术的病例与直接手术的病例进行比较。在前庭神经鞘瘤手术前未行VP分流术的病例中，分析了与术后持续性HCP相关的因素。比较直接手术组和前庭神经鞘瘤手术前VP分流组，面神经保存率和手术并发症发生率具有可比性。在接受直接手术的病例中，75名患者中有10名需要术后永久性脑脊液分流。高龄、男性、症状持续时间、肿瘤体积较大、病灶实变、重度HCP、HCP临床特征与术后是否需要脑脊液分流有关，但无统计学意义。与是否需要额外的HCP治疗相关的最重要的因素是术后血肿的体积&10cc。对于合并HCP的前庭神经鞘瘤，一期肿瘤切除是最佳的治疗方法。术后血肿可能需要密切观察，因为这些患者持续存在HCP的风险增加。
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. 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. 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. 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.