Communicating Hydrocephalus and Vestibular Schwannomas: Etiology, Treatment, and Long-Term Follow-Up

Qasim Al Hinai; Anthony Zeitouni; Denis Sirhan; David Sinclair; Denis Melancon; John Richardson; Richard Leblanc

doi:10.1055/s-0033-1333621

Journal of Neurological Surgery Part B: Skull Base, Table of Contents

J Neurol Surg B Skull Base 2013; 74(02): 068-074
DOI: 10.1055/s-0033-1333621

Original Article

Georg Thieme Verlag KG Stuttgart · New York

Communicating Hydrocephalus and Vestibular Schwannomas: Etiology, Treatment, and Long-Term Follow-Up

Qasim Al Hinai

¹Department of Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montréal, Québec, Canada

,

Anthony Zeitouni

²Department of Otolaryngology, McGill University, Montréal, Québec, Canada

,

Denis Sirhan

¹Department of Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montréal, Québec, Canada

,

David Sinclair

¹Department of Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montréal, Québec, Canada

,

Denis Melancon

³Department of Diagnostic Neuroradiology, Montreal Neurological Institute and Hospital, McGill University, Montréal, Québec, Canada

,

John Richardson

⁴Department of Neuropathology, Montreal Neurological Institute and Hospital, McGill University, Montréal, Québec, Canada

,

Richard Leblanc

¹Department of Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montréal, Québec, Canada

› Author Affiliations

Abstract

Background Large vestibular schwannomas (VSs) can cause hydrocephalus by obstructing the fourth ventricle. Little is known about the communicating hydrocephalus that is seen with a smaller VS.

Methods The clinicopathological findings and follow up of three patients with communicating hydrocephalus associated with a small VS are presented.

Results Four patients aged 40 to 66 years (mean: 57.7) presented with ataxia, dementia, and urinary incontinence. The VS were 2.0 to 2.4 cm. The cerebrospinal fluid (CSF) protein was elevated in three patients in whom it was measured (1.7 to 6 times normal). The VS was resected in two patients. All of the patients required ventriculoperitoneal shunting (VPS). All of the patients were asymptomatic or improved at follow-up at 9 months to 13 years.

Conclusion Communicating hydrocephalus associated with a VS can occur in younger patients than was previously thought. An elevated CSF protein appears to be important, but other factors may be involved. A shunting procedure is often required to relieve the symptoms of hydrocephalus even if the tumor is resected. Possible etiological causes of communicating hydrocephalus in patients with a small VS are discussed.

Keywords

vestibular schwannoma - communicating hydrocephalus

Full Text

References

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