Management of hydrocephalus resulting from acoustic neuromas

Patients with large acoustic neuromas may have secondary obstructive hydrocephalus and occasionally significant neurologic deficit develops. At the House Ear Clinic, we have managed patients with hydrocephalus by translabyrinthine tumor removal without preoperative ventriculoperitoneal shunting. Forty-three patients with documented hydrocephalus who underwent acoustic neuroma removal have been reviewed. Six patients had neurologic deficit resulting from raised intracranial pressure before surgery. In each of these six cases, the deficit resolved after tumor removed without requiring shunting. Two patients had had ventriculoperitoneal shunts inserted because of neurologic deficit before referral for tumor removal. Two other patients underwent postoperative shunting for neurologic deficit --one at 2 weeks and one at 2 years. Cerebral or cerebellar herniation was not noted in any case. Cerebrospinal fluid leak occurred in five patients (11.6%) and culture-positive meningitis in two patients (4.6%). We conclude that decompression by translabyrinthine tumor removal is a safe method of management for patients with hydrocephalus resulting from large acoustic tumors.