Risk factors and tumor response associated with hydrocephalus after gamma knife radiosurgery for vestibular schwannoma

Abstract

This study was designed to investigate the clinical characteristics and risk factors of hydrocephalus after gamma knife radiosurgery (GKRS) for vestibular schwannoma. The authors retrospectively reviewed clinical and neuroimaging findings of 221 patients who underwent GKRS for newly diagnosed vestibular schwannoma. Mean patient age was 54.1 years (range 7–83 years), mean tumor volume was 3,010.4 mm³ (range 34.7 to 14,300 mm³), mean marginal dose was 12.5 Gy (range 11 to 15 Gy), and mean follow-up duration was 31.9 months (range 1 to 107.6 months). Surgical intervention for cerebrospinal fluid (CSF) diversion after GKRS was necessary in 11 (5 %) of the patients. Median time between GKRS and ventriculoperitoneal (VP) shunt placement was 15.5 months (range 1.8–37.8 months). These 11 patients showed female predominance (11 females) and mean tumor volume was significantly larger than in the other without hydrocephalus (6,509 vs. 2,726 mm³; p < 0.01). Decreases in tumor enhancement and swelling were observed in all 221 patients, and CSF protein was found to be elevated in five of nine patients with available data at the time of the shunt procedure. Hydrocephalic symptoms improved after VP shunt and tumor sizes further decreased at last follow-up in all patients. Hydrocephalus after radiosurgery may co-occur with a temporary change of tumor volume after radiation treatment. Therefore, hydrocephalus should be kept in mind during the time of tumor volume transition. Furthermore, the authors suggest that frequent patient monitoring for hydrocephalus be maintained for up to 3–4 years after GKRS.