Vestibular schwannoma combined with hydrocephalus treatment tactic

Objective to develop an algorithm for the management of patients with VS in combination with HC (occlusive, open with increased pressure, normal pressure).Materials and methods. 76 patients with VS in combination with HC were treated at the subtentorial neurooncology department in 2017‒2023. All patients were examined by an ophthalmologist before surgery, in the early postoperative period and at repea­ted examinations after 3, 6 and 12 months. Standard preoperative procedures included CT scan, MRI brain examination with cont­rast, CT scan on the first day after sur­ge­ry, MRI with contrast in the early postoperative period – before discharge, and MRI with contrast in 3, 6 and 12 months. All patients were distributed in subgroups depending on the severity of symptoms of both hydrocephalus and VS, general somatic condition according to the ASA scale and age, and the most reasonable treatment tactics aimed at preserving the quality of life was used.Results. Depending on the type of HC and treatment algorithm patients were divided into 6 groups: I included 37 patients with VS and occlusive or open HC with increased pressure (OOHCIP) and papilledema. In these patients the 1st stage consisted of ventriculoperitoneal shunting (VPS), 2nd – VS removal; II – 6 patients with OOHCIP: 1st – VS removal, 2nd – VPS in whom HC not regressed; III – 13: 6 of whom OOHCIP and 7 with normotensive HC (NHC) – all VPS and observation in dynamics; IV – 9 with VS and NHC underwent VS removal and given the regression of HC VPS was not performed; V – 7 with VS and NHC in whom there was no HC regression after VS removal therefore the 2nd – VPS was carried out; VI – 4 with VS and vicarious HC underwent removal of VS and dynamic observation. Karnofsky scale increased more then 20 % was in groups I, III (OOHCIP), IV and V.Conclusions. For patients with OOHCIP and papilledema, the optimal tactic is 1st – VPS, 2nd –removal of VS. For elderly patients with VS in combination with normotensive or connective HC with increased pressure and concomitant pathology and predominance of HC symptoms it is recommended to conduct first step or only VPS under the follow up and VS removal in case of tumor/clinical signs progression.