Surgical neurology international · 2026
Surgical treatment of large vestibular schwannomas with hydrocephalus in octogenarians: Two cases with favorable functional outcomes.
Клинический случайСтатьяНазвание и аннотация: Перевод пока не подготовлен
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Nonaka Masahiro, Ueno Katsuya, Miyata Mayuko, Isozaki Haruna, Li Yi, Takeda Junichi, Suyama Takehiro, Matsuda Ryosuke
Аннотация
BACKGROUND: The optimal management of vestibular schwannoma (VS) associated with hydrocephalus in octogenarians remains controversial. We report two patients aged 80 years or older with Koos grade IV VS who underwent surgical treatment.
CASE DESCRIPTION: Case 1 involved an 86-year-old woman who presented with progressive gait disturbance caused by a 3.5-cm cystic right VS associated with hydrocephalus. Case 2 involved an 81-year-old woman who presented with cognitive impairment and gait disturbance due to a 3.0-cm cystic left VS with hydrocephalus. In both patients, magnetic resonance imaging demonstrated narrowing of the high-convexity sulci, enlarged Sylvian fissures, and an acute callosal angle. Tumor resection was performed via a retrosigmoid approach with intraoperative facial motor evoked potential (FMEP) monitoring. Tumor dissection was terminated when FMEP amplitudes decreased to <50% of baseline values, resulting in subtotal or near-total tumor resection. Neither patient developed clinically significant postoperative facial nerve dysfunction. Both patients regained independent ambulation. Postoperative imaging demonstrated reduction of ventricular enlargement and improvement of hydrocephalus-related radiological findings. Cognitive function improved substantially in Case 2, with the Mini-Mental State Examination score increasing from 11 to 24. At the latest follow-up, the first patient remained independent without tumor progression or recurrent hydrocephalus 5.9 years after surgery, whereas the second patient maintained independent daily functioning without evidence of tumor progression at 8 months postoperatively.
CONCLUSION: Surgical resection with intraoperative facial nerve monitoring may provide favorable functional and radiological outcomes in carefully selected octogenarians with large VSs associated with hydrocephalus.
CASE DESCRIPTION: Case 1 involved an 86-year-old woman who presented with progressive gait disturbance caused by a 3.5-cm cystic right VS associated with hydrocephalus. Case 2 involved an 81-year-old woman who presented with cognitive impairment and gait disturbance due to a 3.0-cm cystic left VS with hydrocephalus. In both patients, magnetic resonance imaging demonstrated narrowing of the high-convexity sulci, enlarged Sylvian fissures, and an acute callosal angle. Tumor resection was performed via a retrosigmoid approach with intraoperative facial motor evoked potential (FMEP) monitoring. Tumor dissection was terminated when FMEP amplitudes decreased to <50% of baseline values, resulting in subtotal or near-total tumor resection. Neither patient developed clinically significant postoperative facial nerve dysfunction. Both patients regained independent ambulation. Postoperative imaging demonstrated reduction of ventricular enlargement and improvement of hydrocephalus-related radiological findings. Cognitive function improved substantially in Case 2, with the Mini-Mental State Examination score increasing from 11 to 24. At the latest follow-up, the first patient remained independent without tumor progression or recurrent hydrocephalus 5.9 years after surgery, whereas the second patient maintained independent daily functioning without evidence of tumor progression at 8 months postoperatively.
CONCLUSION: Surgical resection with intraoperative facial nerve monitoring may provide favorable functional and radiological outcomes in carefully selected octogenarians with large VSs associated with hydrocephalus.