Communicating hydrocephalus associated with surgery or radiosurgery for vestibular schwannoma

The purpose of this cohort study was to determine the incidence of communicating hydrocephalus (HCP) associated with the treatment of vestibular schwannoma (VS). Between January 2002 and December 2007, a total of 291 patients diagnosed with VS underwent either surgical resection or gamma knife radiosurgery (GKS). By analyzing the clinical data and MRI scans, we retrospectively reviewed and compared the incidence of communicating HCP between the two treatment modalities. During their clinical course, 10 of 291 patients developed new communicating HCP (3.4%): nine of 90 patients who were treated using GKS (10%) developed communicating HCP post-procedure, while only one of 146 patients who underwent surgical resection alone (0.68%) developed subsequent communicating HCP (p = 0.002). The median event-free survival from the initial treatment with GKS to the development of communicating HCP was 22 months (range: 7-55 months). Three patients who developed new communicating HCP in the GKS group required surgical intervention, including ventriculoperitoneal shunt or endoscopic third ventriculostomy. There was no significant correlation between sex or tumor size and the incidence of communicating HCP in the GKS group (p > 0.05). We found a relatively high incidence of communicating HCP after treatment in patients with VS, particularly for those patients in the GKS group. Therefore, the risk of communicating HCP should be considered in the follow-up of patients who undergo GKS for treatment of VS.