European Journal of Preventive Medicine

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An MR Imaging Study of Communicating Hydrocephalus After Gamma Knife Radiosurgery for Vestibular Schwannoma

Received: 27 January 2024    Accepted: 12 February 2024    Published: 29 February 2024
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Abstract

Patients with vestibular schwannoma (VS) face a 3.7-23.7% risk developing hydrocephalus. Small-sized VS are associated with communicating or non-communicating hydrocephalus. Hydrocephalus in VS patients can persist or worsen post-tumor removal. Gamma knife radiosurgery is effective, especially in younger patients with functional hearing. Although the causal relationship between gamma knife radiosurgery and hydrocephalus isn't firmly established, this case reports a possible association between developing hydrocephalus and Vestibular schwannoma. Elevated CSF protein suggests communicating hydrocephalus due to tumor necrosis. The rarity of hydrocephalus post-gamma knife surgery likely relates to tumor variations rather than procedural nuances. Gamma Knife radiosurgery for vestibular schwannomas can lead to communicative hydrocephalus. MR imaging, including pre- and post-treatment scans, along with MR CSF cine-flow studies, highlights the link between gamma knife involvement and hydrocephalus development. Despite the rarity, this negative outcome underscores the need for careful consideration and investigation of risk factors associated with hydrocephalus post-radiosurgery. A middle aged man with vestibular schwannoma was investigated in this case. Patient was procedure through gamma knife radiosurgery for vestibular schwannoma. Patient was passed through MR scans before the radio surgical procedure and 9 months past surgical procedure. Nine months later, severe ventriculomegaly was observed, revealing central necrosis in the tumor. Lumbar puncture indicated abnormal CSF characteristics without evidence of infection. Despite a failed endoscopic third ventriculostomy, MR imaging cine-flow studies confirmed free CSF flow, emphasizing the complexity of managing hydrocephalus post-gamma knife radiosurgery for vestibular schwannomas. VS typically occurs in older individuals, this case's younger age and optimal tumor size for gamma knife treatment add complexity. Faster-growing and larger tumors are more prone to post-treatment necrosis and hydrocephalus, necessitating careful management. MR cine-flow aids in hydrocephalus differentiation.

DOI 10.11648/j.ejpm.20241201.13
Published in European Journal of Preventive Medicine (Volume 12, Issue 1, February 2024)
Page(s) 13-16
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Gamma Knife, Radiosurgery, Hydrocephalus, Schwannoma, MR Imaging

References
[1] Shin, D. A.-O., et al., Treatment Outcome of Hydrocephalus Associated with Vestibular Schwannoma. (1738-6586 (Print)).
[2] Al Hinai, Q., et al., Communicating hydrocephalus and vestibular schwannomas: etiology, treatment, and long-term follow-up. (2193-6331 (Print)).
[3] Yadav, Y. R., et al., Endoscopic third ventriculostomy. J Neurosci Rural Pract, 2012. 3(2): p. 163-73.
[4] Boari, N., et al., Gamma Knife radiosurgery for vestibular schwannoma: clinical results at long-term follow-up in a series of 379 patients. (1933-0693 (Electronic)).
[5] Flickinger, J. C., et al., Results of acoustic neuroma radiosurgery: an analysis of 5 years' experience using current methods. (0022-3085 (Print)).
[6] Morelli, D., et al., Persistent hydrocephalus after early surgical management of posterior fossa tumors in children: is routine preoperative endoscopic third ventriculostomy justified? (0022-3085 (Print)).
[7] Pirouzmand, F., J. Tator Ch Fau - Rutka, and J. Rutka, Management of hydrocephalus associated with vestibular schwannoma and other cerebellopontine angle tumors. (0148-396X (Print)).
[8] Prabhuraj, A. R., et al., Hydrocephalus Associated with Large Vestibular Schwannoma: Management Options and Factors Predicting Requirement of Cerebrospinal Fluid Dive rsion after Primary Surgery. Journal of neurosciences in rural practice. 8(Suppl 1): p. S27-S32.
[9] Kim, J., et al., Communicating Hydrocephalus Following Treatment of Cerebellopontine An gle Tumors. World neurosurgery. 165: p. e505-e511.
[10] Thomsen, J., S. E. Tos M Fau - Børgesen, and S. E. Børgesen, Gamma knife: hydrocephalus as a complication of stereotactic radiosurgical treatment of an acoustic neuroma. (0192-9763 (Print)).
[11] Linskey, M. E., et al., Stereotactic radiosurgery for acoustic tumors. (1042-3680 (Print)).
[12] Gardner Wj Fau - Spitler, D. K., C. Spitler Dk Fau - Whitten, and C. Whitten, Increased intracranial pressure caused by increased protein content in the cerebrospinal fluid; an explanation of papilledema in certain cases of small intracranial and intraspinal tumors, and in the Guillain-Barre syndrome. (0028-4793 (Print)).
[13] Rosenberg, S. I., Natural history of acoustic neuromas. (0023-852X (Print)).
[14] van Leeuwen, J. P., et al., Acoustic neuroma: correlation among tumor size, symptoms, and patient age. (0023-852X (Print)).
[15] Cioffi, G., et al., Epidemiology of vestibular schwannoma in the United States, 2004-2016. (2632-2498 (Electronic)).
[16] Reznitsky, M., et al., Epidemiology and Diagnostic Characteristics of Vestibular Schwannomas-Does Gender Matter? (1537-4505 (Electronic)).
[17] Vorasubin, N., et al., Factors That Affect Length of Hospital Stay After Vestibular Schwannoma Surgery. (1537-4505 (Electronic)).
[18] Rosahl, S., et al., Diagnostics and therapy of vestibular schwannomas - an interdisciplinary challenge. (1865-1011 (Print)).
[19] Hwang, S.-K., et al., Aggressive Vestibular Schwannomas with Postoperative Rapid Growth: Clinicopathological Analysis of 15 Cases. Neurosurgery, 2002. 51(6): p. 1381-1391.
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    Melese, E. B., Alhussain, H., Ayalew, F. B., Woldehana, N. A., Ayana, M. G., et al. (2024). An MR Imaging Study of Communicating Hydrocephalus After Gamma Knife Radiosurgery for Vestibular Schwannoma. European Journal of Preventive Medicine, 12(1), 13-16. https://doi.org/10.11648/j.ejpm.20241201.13

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    ACS Style

    Melese, E. B.; Alhussain, H.; Ayalew, F. B.; Woldehana, N. A.; Ayana, M. G., et al. An MR Imaging Study of Communicating Hydrocephalus After Gamma Knife Radiosurgery for Vestibular Schwannoma. Eur. J. Prev. Med. 2024, 12(1), 13-16. doi: 10.11648/j.ejpm.20241201.13

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    AMA Style

    Melese EB, Alhussain H, Ayalew FB, Woldehana NA, Ayana MG, et al. An MR Imaging Study of Communicating Hydrocephalus After Gamma Knife Radiosurgery for Vestibular Schwannoma. Eur J Prev Med. 2024;12(1):13-16. doi: 10.11648/j.ejpm.20241201.13

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  • @article{10.11648/j.ejpm.20241201.13,
      author = {Endalkachew Belayneh Melese and Haitham Alhussain and Fekadu Belay Ayalew and Nathnael Abera Woldehana and Motuma Gonfa Ayana and Simon Tsegaye Geleta and Ruth Betremariam Abebe and Abrham Workineh Azale and Wondimagegn Tibebu Tilahun},
      title = {An MR Imaging Study of Communicating Hydrocephalus After Gamma Knife Radiosurgery for Vestibular Schwannoma},
      journal = {European Journal of Preventive Medicine},
      volume = {12},
      number = {1},
      pages = {13-16},
      doi = {10.11648/j.ejpm.20241201.13},
      url = {https://doi.org/10.11648/j.ejpm.20241201.13},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ejpm.20241201.13},
      abstract = {Patients with vestibular schwannoma (VS) face a 3.7-23.7% risk developing hydrocephalus. Small-sized VS are associated with communicating or non-communicating hydrocephalus. Hydrocephalus in VS patients can persist or worsen post-tumor removal. Gamma knife radiosurgery is effective, especially in younger patients with functional hearing. Although the causal relationship between gamma knife radiosurgery and hydrocephalus isn't firmly established, this case reports a possible association between developing hydrocephalus and Vestibular schwannoma. Elevated CSF protein suggests communicating hydrocephalus due to tumor necrosis. The rarity of hydrocephalus post-gamma knife surgery likely relates to tumor variations rather than procedural nuances. Gamma Knife radiosurgery for vestibular schwannomas can lead to communicative hydrocephalus. MR imaging, including pre- and post-treatment scans, along with MR CSF cine-flow studies, highlights the link between gamma knife involvement and hydrocephalus development. Despite the rarity, this negative outcome underscores the need for careful consideration and investigation of risk factors associated with hydrocephalus post-radiosurgery. A middle aged man with vestibular schwannoma was investigated in this case. Patient was procedure through gamma knife radiosurgery for vestibular schwannoma. Patient was passed through MR scans before the radio surgical procedure and 9 months past surgical procedure. Nine months later, severe ventriculomegaly was observed, revealing central necrosis in the tumor. Lumbar puncture indicated abnormal CSF characteristics without evidence of infection. Despite a failed endoscopic third ventriculostomy, MR imaging cine-flow studies confirmed free CSF flow, emphasizing the complexity of managing hydrocephalus post-gamma knife radiosurgery for vestibular schwannomas. VS typically occurs in older individuals, this case's younger age and optimal tumor size for gamma knife treatment add complexity. Faster-growing and larger tumors are more prone to post-treatment necrosis and hydrocephalus, necessitating careful management. MR cine-flow aids in hydrocephalus differentiation.
    },
     year = {2024}
    }
    

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    T1  - An MR Imaging Study of Communicating Hydrocephalus After Gamma Knife Radiosurgery for Vestibular Schwannoma
    AU  - Endalkachew Belayneh Melese
    AU  - Haitham Alhussain
    AU  - Fekadu Belay Ayalew
    AU  - Nathnael Abera Woldehana
    AU  - Motuma Gonfa Ayana
    AU  - Simon Tsegaye Geleta
    AU  - Ruth Betremariam Abebe
    AU  - Abrham Workineh Azale
    AU  - Wondimagegn Tibebu Tilahun
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    PY  - 2024
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    DO  - 10.11648/j.ejpm.20241201.13
    T2  - European Journal of Preventive Medicine
    JF  - European Journal of Preventive Medicine
    JO  - European Journal of Preventive Medicine
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    VL  - 12
    IS  - 1
    ER  - 

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Author Information
  • Johns Hopkins Boomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America

  • Department of Public Health and Infection Control, King Fahad Hospital, Alhofuf, Saudi Arabia

  • Johns Hopkins Boomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America

  • Johns Hopkins Boomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America

  • Department of Internal Medicine, University of Gondar, Addis Ababa, Ethiopia

  • Department of Internal Medicine, University of Gondar, Addis Ababa, Ethiopia

  • Department of Internal Medicine, University of Gondar, Addis Ababa, Ethiopia

  • Department of Internal Medicine, Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia

  • Department of Internal Medicine, University of Gondar, Addis Ababa, Ethiopia

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