Moreira Alejandra, Rodezno Alejandra, Santos David, Telles Adriana, Ramirez Juliana, Lovo Eduardo E
Neurosurgery, International Cancer Center, San Salvador, SLV.
Radiosurgery, International Cancer Center, San Salvador, SLV.
Cureus. 2022 Sep 13;14(9):e29129. doi: 10.7759/cureus.29129. eCollection 2022 Sep.
Introduction Hydrocephalus is a build-up of cerebrospinal fluid (CSF) in the brain and is characterized by abnormal dilatation of the cerebral ventricles. Patients can be either asymptomatic, have symptoms related to primary tumors, or have hydrocephalus-related symptoms. Generally, symptomatic patients are candidates for ventriculoperitoneal (VP) shunt placement to reduce acute symptoms. Little evidence exists regarding the resolution of symptomatic hydrocephalus secondary to brain tumors using stereotactic radiosurgery (SRS) alone as a primary treatment option. Methods The present study is a retrospective series of eight patients (six men and two women) diagnosed with obstructive hydrocephalus due to brain tumors treated with radiosurgery between April 2013 and February 2021. The primary endpoint of the present study is to report our institutional experience regarding the control of symptomatic obstructive hydrocephalus due to brain tumors treated with upfront radiosurgery. Results The mean age was 52 years (range, 5-79). The most common presenting symptoms included headache (100%), vision-related symptoms (75%), and ataxia (37.5%). All patients showed symptom improvement after radiosurgery, five (62.5%) patients showed resolution in less than three days and the rest of the patients resolved hydrocephalus in a longer timeframe (more than three days). All patients lowered their Evans index compared to the index documented before radiosurgery, in a range from 0.02 to 0.17. Conclusion Radiosurgery is a non-invasive alternative treatment for primary and secondary brain tumors that debut with obstructive hydrocephalus, tumors expected to have a high alpha/beta ratio might be suitable to attempt radiosurgery to avoid permanently implanted devices such as VP shunts or other invasive procedures such as a third ventriculostomy. The present study demonstrated that in selected cases SRS can lead to hydrocephalus symptom resolution along with a decrease in ventricular size in a relatively short time frame. Little evidence exists regarding the effect of SRS on symptomatic hydrocephalus resolution and further histology-specific studies are required. We acknowledge that this approach requires immediate access to radiosurgery and close clinical follow-up to ensure success.
引言
脑积水是指脑脊液（CSF）在脑内积聚，其特征为脑室异常扩张。患者可能无症状，或出现与原发性肿瘤相关的症状，亦或有与脑积水相关的症状。一般而言，有症状的患者是脑室腹腔（VP）分流术的候选对象，以减轻急性症状。关于单独使用立体定向放射外科（SRS）作为主要治疗选择来解决继发于脑肿瘤的症状性脑积水，几乎没有证据。
方法
本研究是一项回顾性系列研究，纳入了2013年4月至2021年2月期间接受放射外科治疗的8例因脑肿瘤导致梗阻性脑积水的患者（6例男性和2例女性）。本研究的主要终点是报告我们机构对于采用 upfront 放射外科治疗因脑肿瘤导致的症状性梗阻性脑积水的控制经验。
结果
平均年龄为52岁（范围5 - 79岁）。最常见的首发症状包括头痛（100%）、视力相关症状（75%）和共济失调（37.5%）。放射外科治疗后所有患者症状均有改善，5例（62.5%）患者在不到三天内症状缓解，其余患者在更长时间内（超过三天）脑积水得到缓解。与放射外科治疗前记录的指数相比，所有患者的Evans指数均降低，范围为0.02至0.17。
结论
放射外科是一种针对首发梗阻性脑积水的原发性和继发性脑肿瘤的非侵入性替代治疗方法，预期具有高α/β比值的肿瘤可能适合尝试放射外科治疗，以避免永久性植入装置如VP分流术或其他侵入性手术如第三脑室造瘘术。本研究表明，在特定病例中，SRS可在相对较短的时间内使脑积水症状缓解并使脑室大小减小。关于SRS对症状性脑积水缓解的影响几乎没有证据，需要进一步进行组织学特异性研究。我们承认这种方法需要能够立即进行放射外科治疗并进行密切的临床随访以确保成功。
