The risk factors of symptomatic communicating hydrocephalus after stereotactic radiosurgery for vestibular schwannoma: The Implication of Brain AtrophyJung Ho Han1, DONG GYU KIM2, Hyun-Tai Chung, PhD3, SUN HA PAEK2, CHAE-YONG KIM4, CHANG WAN OH4, YOUNG-HOON KIM4, JIN WOOK KIM21Gyeonggi-Do, Korea, Republic Of 2Department of Neurosurgery, Seoul National University Hospital 3Seoul National University College of Medicine 4Department of Neurosurgery, Seoul National University Bundang Hospital Keywords: vestibular schwannoma, hydrocephalus, radiosurgery, cerebral atrophy, risk factorInteractive ManuscriptAsk Questions of this Manuscript: What is the background behind your study?Hydrocephalus may develop after vestibular schwannoma radiosurgery, radiotherapy, or resection. What is the purpose of your study?Our purpose was to identify the effect of brain atrophy on the development of symptomatic communicating hydrocephalus (SCHCP) after stereotactic radiosurgery (SRS) for sporadic unilateral vestibular schwannomas (VS). Describe your patient group.One hundred eighty-one patients (40.8%) were male, and the mean age of the patients was 53±13 years (range, 11–81). Describe what you did.A total of 444 patients with VS were treated with SRS as a primary treatment. The mean follow-up duration was 56.8±35.8 months (range, 12–160). The mean tumor volume was 2.78±3.33 cm3 (range, 0.03–23.30). The cross-sectional area of the lateral ventricle (CALV), defined as the area of the lateral ventricle at the level of the mammillary body, was measured on coronal T1-weighted MR images as an indicator of brain atrophy. Describe your main findings.At the distant follow-up, a total of 25 (5.6%) patients had SCHCP. The median time to symptom development was 7 months (range, 1–48). The mean CALV was 335.0±193.8 mm2 (range, 44.65–1171). The intraclass correlation coefficient was 0.988 (95% CI, 0.976–0.994; p<0.001). In the multivariate analysis, the CALV had a significant relationship with the development of SCHCP (p<0.001; OR=1.005; 95% CI, 1.002–1.007). Tumor volume and female gender also had a significant association (p<0.001; OR=1.246; 95% CI, 1.103–1.409; p<0.009; OR=7.256; 95% CI, 1.656–31.797). However, age failed to show any relationship with the development of SCHCP (p=0.364). Describe the main limitation of this study.This was a retrospective study. Describe your main conclusion.Brain atrophy may provoke SCHCP after SRS, especially in female patients with a large VS. Describe the importance of your findings and how they can be used by others.Follow-up surveillance should be individualized, considering the risk factors involved for each patient, for prompt diagnosis of SCHCP. Hydrocephalus may develop after vestibular schwannoma radiosurgery, radiotherapy, or resection. Our purpose was to identify the effect of brain atrophy on the development of symptomatic communicating hydrocephalus (SCHCP) after stereotactic radiosurgery (SRS) for sporadic unilateral vestibular schwannomas (VS). One hundred eighty-one patients (40.8%) were male, and the mean age of the patients was 53±13 years (range, 11–81). A total of 444 patients with VS were treated with SRS as a primary treatment. The mean follow-up duration was 56.8±35.8 months (range, 12–160). The mean tumor volume was 2.78±3.33 cm3 (range, 0.03–23.30). The cross-sectional area of the lateral ventricle (CALV), defined as the area of the lateral ventricle at the level of the mammillary body, was measured on coronal T1-weighted MR images as an indicator of brain atrophy. At the distant follow-up, a total of 25 (5.6%) patients had SCHCP. The median time to symptom development was 7 months (range, 1–48). The mean CALV was 335.0±193.8 mm2 (range, 44.65–1171). The intraclass correlation coefficient was 0.988 (95% CI, 0.976–0.994; p<0.001). In the multivariate analysis, the CALV had a significant relationship with the development of SCHCP (p<0.001; OR=1.005; 95% CI, 1.002–1.007). Tumor volume and female gender also had a significant association (p<0.001; OR=1.246; 95% CI, 1.103–1.409; p<0.009; OR=7.256; 95% CI, 1.656–31.797). However, age failed to show any relationship with the development of SCHCP (p=0.364). This was a retrospective study. Brain atrophy may provoke SCHCP after SRS, especially in female patients with a large VS. Follow-up surveillance should be individualized, considering the risk factors involved for each patient, for prompt diagnosis of SCHCP. Project Roles:
J. Han (), D. KIM (), H. Chung (), S. PAEK (), C. KIM (), C. OH (), Y. KIM (), J. KIM ()
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