Communicating Hydrocephalus After Radiotherapy for a Vestibular Schwannoma

Hydrocephalus is a known tumour complication associated with vestibular schwannomas, which can be either the obstructive or communicating (non-obstructive) type. The latter represents a rare and controversial complication following radiotherapy, typically resulting from tumour necrosis. Management generally involves cerebrospinal fluid diversion. Here, we present a case of normal-pressure and communicating hydrocephalus that developed after radiotherapy for a vestibular schwannoma. The patient was a 72-year-old woman who initially presented with imbalance and right sensorineural hearing loss. An MRI scan identified an enhancing mass in the right cerebellopontine angle and the right internal auditory meatus, consistent with a diagnosis of a right vestibular schwannoma. Following evidence of increased tumour growth on subsequent MRI scans, the patient underwent radiotherapy with a total dose of 50 Gy delivered in 30 fractions, utilising the volumetric modulated arc therapy technique. Sixteen months after radiotherapy, the patient experienced new neurological symptoms, including intermittent slurred speech, loss of concentration, slow cognition, right facial asymmetry, numbness, and recurrent falls. CT of the head showed communicating hydrocephalus. Therefore, a left ventriculoperitoneal shunt was subsequently inserted for the management of hydrocephalus. However, due to shunt blockage, the patient underwent near-total resection of the enlarging vestibular schwannoma and has since been followed by the neurosurgical team.