title: The risk factors of symptomatic communicating hydrocephalus after stereotactic radiosurgery for unilateral vestibular schwannoma: the implication of brain atrophy.
abstract: OBJECTIVE
  To identify the effect of brain atrophy on the development of symptomatic communicating hydrocephalus (SCHCP) after stereotactic radiosurgery (SRS) for sporadic unilateral vestibular schwannomas (VS).
  
  
  METHODS
  A total of 444 patients with VS were treated with SRS as a primary treatment. One hundred eighty-one patients (40.8%) were male, and the mean age of the patients was 53±13 years (range, 11-81 years). The mean follow-up duration was 56.8±35.8 months (range, 12-160 months). The mean tumor volume was 2.78±3.33 cm3 (range, 0.03-23.30 cm3). The cross-sectional area of the lateral ventricles (CALV), defined as the combined area of the lateral ventricles at the level of the mammillary body, was measured on coronal T1-weighted magnetic resonance images as an indicator of brain atrophy.
  
  
  RESULTS
  At distant follow-up, a total of 25 (5.6%) patients had SCHCP. The median time to symptom development was 7 months (range, 1-48 months). The mean CALV was 334.0±194.0 mm2 (range, 44.70-1170 mm2). The intraclass correlation coefficient was 0.988 (95% confidence interval [CI], 0.976-0.994; p<0.001). In multivariate analysis, the CALV had a significant relationship with the development of SCHCP (p<0.001; odds ration [OR]=1.005; 95% CI, 1.002-1.007). Tumor volume and female sex also had a significant association (p<0.001; OR=1.246; 95% CI, 1.103-1.409; p<0.009; OR=7.256; 95% CI, 1.656-31.797, respectively). However, age failed to show any relationship with the development of SCHCP (p=0.364).
  
  
  CONCLUSIONS
  Brain atrophy may be related to de novo SCHCP after SRS, especially in female patients with a large VS. Follow-up surveillance should be individualized, considering the risk factors involved for each patient, for prompt diagnosis of SCHCP.
authors.affiliation: Department of Neurosurgery, Seoul National University Bundang Hospital, Gyeonggi-do, Korea.
authors.forename: Jung Ho
authors.initials: JH
authors.lastname: Han
authors.forename: Dong Gyu
authors.initials: DG
authors.lastname: Kim
authors.forename: Hyun-Tai
authors.initials: HT
authors.lastname: Chung
authors.forename: Sun Ha
authors.initials: SH
authors.lastname: Paek
authors.forename: Chul-Kee
authors.initials: CK
authors.lastname: Park
authors.forename: Chae-Yong
authors.initials: CY
authors.lastname: Kim
authors.forename: Seung-Sik
authors.initials: SS
authors.lastname: Hwang
authors.forename: Jeong-Hoon
authors.initials: JH
authors.lastname: Park
authors.forename: Young-Hoon
authors.initials: YH
authors.lastname: Kim
authors.forename: Jin Wook
authors.initials: JW
authors.lastname: Kim
authors.forename: Yong Hwy
authors.initials: YH
authors.lastname: Kim
authors.forename: Sang Woo
authors.initials: SW
authors.lastname: Song
authors.forename: In Kyung
authors.initials: IK
authors.lastname: Kim
authors.forename: Hee-Won
authors.initials: HW
authors.lastname: Jung
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001284:Atrophy / Q000150:complications; D001921:Brain / Q000473:pathology*; D002648:Child; D016001:Confidence Intervals; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006849:Hydrocephalus / Q000209:etiology*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009464:Neuroma, Acoustic / Q000473:pathology / Q000601:surgery*; D016634:Radiosurgery / Q000009:adverse effects / Q000379:methods*; D012307:Risk Factors; D012737:Sex Factors; D013997:Time Factors; D047368:Tumor Burden; D055815:Young Adult