Treatment outcomes of hydrocephalus management strategies in patients with cerebellopontine angle lesions

Document Type

Article

Department

General Surgery; Neurosurgery

Abstract

Background: Approximately 3.7-42% of cerebellopontine angle (CPA) lesions may present with symptomatic or asymptomatic Hydrocephalus (HCP), often due to cerebrospinal fluid blockage at the fourth ventricle. The optimal management strategy remains a topic of debate. This study aims to investigate the occurrence of HCP, persistence following surgery, and the factors affecting their surgical outcomes.
Materials and methods: This retrospective observational study included patients aged over 13 with CPA lesions who underwent surgical resection, while those with secondary CPA tumors or who had only CSF diversion without resection were excluded. Data was extracted from patients' medical records and analyzed using SPSS 21.
Results: A total of 141 patients with CP angle lesions were identified, among which 46.8% (n = 66) had preoperative HCP as diagnosed by an Evans ratio greater than 0.3. The mean age at diagnosis was 41.81 years (± 14.21). Persistent HCP was observed in 19 patients (those who required permanent postoperative CSF diversion and/or with Evans ratio ≥ 3). Among the patients with HCP, 6.06% (4/66) had severe HCP (Evans ratio > 0.4). Only 3 out of 75 patients without pre-op HCP developed new-onset Post-op HCP. Persistent HCP was significantly correlated with pre-resection external ventricular drainage (EVD), whether as a separate procedure (p = 0.002) or performed in the same setting (p = 0.0001). Intraoperative lumbar drainage, however, was not correlated with persistent HCP (p = 0.360). Preoperative HCP resolved significantly in those who achieved gross total resection, as the extent of resection was significantly correlated with HCP persistence (p = 0.013).
Conclusion: EVD, whether placed emergently before or during surgical resection, is correlated with a risk of persistent postoperative HCP, often necessitating permanent CSF diversion. A higher extent of tumor resection reduces the likelihood of persistent postoperative HCP. Since over 56% of preoperative HCP cases resolve following lesion resection, permanent CSF diversion before surgery can be avoided when possible.

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Volume. issue, and pagination are not provided by the author/publisher.

Publication (Name of Journal)

Acta Neurologica Belgica

DOI

10.1007/s13760-026-03083-z

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