Keulen Marte van, Pace Jonathan, Burant Christopher J, Penn David L, Wilson Betsy, Ronald Andrew, Mowry Sarah E, Megerian Cliff A, Bambakidis Nicholas C
Department of Neurological Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, United States.
Case Western Reserve University, Cleveland, Ohio, United States.
J Neurol Surg B Skull Base. 2021 Mar 8;83(Suppl 2):e191-e200. doi: 10.1055/s-0041-1725032. eCollection 2022 Jun.
The incidence of vestibular schwannoma is reported as 12 to 54 new cases per million per year, increasing over time. These patients usually present with unilateral sensorineural hearing loss, tinnitus, or vertigo. Rarely, these patients present with symptoms of hydrocephalus or vision changes. The study aimed to evaluate the surgical management of vestibular schwannoma at a single institution and to identify factors that may contribute to hydrocephalus, papilledema, and the need for pre-resection diversion of cerebrospinal fluid. A retrospective review examining the data of 203 patients with vestibular schwannoma managed with surgical resection from May 2008 to May 2020. We stratified patients into five different groups to analyze: tumors with a diameter of ≥40 mm, clinical evidence of hydrocephalus, and of papilledema, and patients who underwent pre-resection cerebrospinal fluid (CSF) diversion. From May 2008 to May 2020, 203 patients were treated with surgical resection. Patients with tumors ≥40 mm were more likely to present with visual symptoms ( < 0.001). Presentation with hydrocephalus was associated with larger tumor size ( < 0.001) as well as concomitant visual symptoms and papilledema ( < 0.001). Patients with visual symptoms presented at a younger age ( = 0.002) and with larger tumors ( < 0.001). This case series highlights the rare presentation of vision changes and hydrocephalus in patients with vestibular schwannoma. We recommend urgent CSF diversion for patients with visual symptoms and hydrocephalus, followed by definitive resection. Further, vision may still deteriorate even after CSF diversion and tumor resection.
据报道，前庭神经鞘瘤的发病率为每年每百万人口中有12至54例新发病例，且呈逐年上升趋势。这些患者通常表现为单侧感音神经性听力损失、耳鸣或眩晕。极少数情况下，这些患者会出现脑积水或视力改变的症状。 本研究旨在评估单一机构中前庭神经鞘瘤的手术治疗情况，并确定可能导致脑积水、视乳头水肿以及术前脑脊液分流需求的因素。 一项回顾性研究，分析了2008年5月至2020年5月期间接受手术切除治疗的203例前庭神经鞘瘤患者的数据。我们将患者分为五个不同组进行分析：肿瘤直径≥40毫米、有脑积水临床证据、有视乳头水肿的患者，以及接受术前脑脊液分流的患者。 2008年5月至2020年5月期间，203例患者接受了手术切除。肿瘤≥40毫米的患者更易出现视觉症状（<0.001）。出现脑积水与肿瘤较大尺寸相关（<0.001），同时也与视觉症状和视乳头水肿相关（<0.001）。有视觉症状的患者发病年龄较轻（=0.002）且肿瘤较大（<0.001）。 本病例系列突出了前庭神经鞘瘤患者中视力改变和脑积水的罕见表现。我们建议对有视觉症状和脑积水的患者紧急进行脑脊液分流，随后进行确定性切除。此外，即使在脑脊液分流和肿瘤切除后，视力仍可能恶化。
