[Recurrent giant cystic vestibular schwannomas: role of cystoperitoneal shunt].
BACKGROUND
Surgical removal of giant cystic vestibular schwannomas is difficult because of adherences between the cyst membrane, brainstem, and the VII-VIII nerve complex. The recurrence of the cyst is frequent and requires reoperation. The aim of this study was to analyze the role of the palliative cystoperitoneal shunt in giant cystic vestibular schwannomas.


METHODS
Eighty-eight patients with a diagnosis of stage III or IV vestibular schwannoma were managed surgically from January 2000 to December 2005 in our department. Six schwannomas were deemed to be cystic according to the following criteria: a voluminous cystic component with mass effect causing symptoms as well as radiological and intraoperative identification of cystic elements.


RESULTS
Complete tumor removal was achieved in two patients. After a follow-up of 5 and 7 years, these patients were asymptomatic. In four cases, we performed cyst drainage. For three patients, we implanted a permanent cystoperitoneal shunt. These patients were asymptomatic with a mean follow-up of 19.7 months.


CONCLUSIONS
The cystoperitoneal shunt with no valve is a valid palliative surgical solution to remove brain stem compression. Neuronavigation allows proper positioning of the drain and secures the procedure.
Dagain
A
A
Service de neurochirurgie, HIA Val-de-Grâce, 75005 Paris, France. dr.adagain@gmail.com
Dutertre
G
G
Pouit
B
B
Dulou
R
R
Delmas
J-M
JM
Poncet
J-L
JL
Desgeorges
M
M
Pernot
P
P
D000368:Aged; D000369:Aged, 80 and over; D020863:Central Nervous System Cysts / Q000473:pathology / Q000601:surgery; D004322:Drainage; D004428:Ear Neoplasms / Q000473:pathology / Q000601:surgery*; D005154:Facial Nerve / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009408:Nerve Compression Syndromes / Q000209:etiology / Q000601:surgery; D009464:Neuroma, Acoustic / Q000473:pathology / Q000601:surgery*; D019635:Neurosurgical Procedures / Q000009:adverse effects; D010166:Palliative Care; D010537:Peritoneum / Q000601:surgery; D017211:Treatment Failure