Fluid-fluid level in cystic vestibular schwannoma: a predictor of peritumoral adhesion

Clinical article

Lei Xia M.D., Ph.D.1, Hongwei Zhang M.D., Ph.D.1, Chunjiang Yu M.D., Ph.D.1, Mingshan Zhang M.D., Ph.D.1, Ming Ren M.D., Ph.D.1, Yanming Qu M.D., Ph.D.1, Haoran Wang M.D.1, Mingwang Zhu M.D., Ph.D.2, Dianjiang Zhao M.D., Ph.D.2, Xueling Qi M.D., Ph.D.3, and Kun Yao M.D., Ph.D.3
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  • 1 Departments of Neurosurgery,
  • | 2 Radiology, and
  • | 3 Pathology, Beijing Sanbo Brain Hospital, Capital Medical University, Beijing, China
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Object

The aim of this study was to evaluate the clinical results and surgical outcomes of cystic vestibular schwannomas (VSs) with fluid-fluid levels.

Methods

Forty-five patients with cystic VSs and 86 with solid VSs were enrolled in the study. The patients in the cystic VSs were further divided into those with and without fluid-fluid levels. The clinical and neuroimaging features, intraoperative findings, and surgical outcomes of the 3 groups were retrospectively compared.

Results

Peritumoral adhesion was significantly greater in the fluid-level group (70.8%) than in the nonfluid-level group (28.6%) and the solid group (25.6%; p < 0.0001). Complete removal of the VS occurred significantly less in the fluid-level group (45.8%, 11/24) than in the nonfluid-level group (76.2%, 16/21) and the solid group (75.6%, 65/86; p = 0.015). Postoperative facial nerve function in the fluid-level group was less favorable than in the other 2 groups; good/satisfactory facial nerve function 1 year after surgery was noted in 50.0% cases in the fluid-level group compared with 83.3% cases in the nonfluid-level group (p = 0.038).

Conclusions

Cystic VSs with fluid-fluid levels more frequently adhered to surrounding neurovascular structures and had a less favorable surgical outcome. A possible mechanism of peritumoral adhesion is intratumoral hemorrhage and consequent inflammatory reactions that lead to destruction of the tumor-nerve barrier. These findings may be useful in predicting surgical outcome and planning surgical strategy preoperatively.

Abbreviations used in this paper:

DRIVE = driven equilibrium; PICA = posterior inferior cerebellar artery; TSE = turbo spin echo; VS = vestibular schwannoma.

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  • 1

    Asari S, , Katayama S, , Itoh T, , Tsuchida S, & Ohmoto T: CT and MRI of haemorrhage into intracranial neuromas. Neuroradiology 35:247250, 1993

    • Search Google Scholar
    • Export Citation
  • 2

    Benech F, , Perez R, , Fontanella MM, , Morra B, , Albera R, & Ducati A: Cystic versus solid vestibular schwannomas: a series of 80 grade III-IV patients. Neurosurg Rev 28:209213, 2005

    • Search Google Scholar
    • Export Citation
  • 3

    Charabi S, , Klinken L, , Mantoni M, , Tos M, & Thomsen J: Histology and neuro-imaging in cystic acoustic neuromas. Acta Otolaryngol 113:519523, 1993

    • Search Google Scholar
    • Export Citation
  • 4

    Charabi S, , Klinken L, , Tos M, & Thomsen J: Histopathology and growth pattern of cystic acoustic neuromas. Laryngoscope 104:13481352, 1994

    • Search Google Scholar
    • Export Citation
  • 5

    Charabi S, , Tos M, , Børgesen SE, & Thomsen J: Cystic acoustic neuromas. Results of translabyrinthine surgery. Arch Otolaryngol Head Neck Surg 120:13331338, 1994

    • Search Google Scholar
    • Export Citation
  • 6

    Charabi S, , Tos M, , Thomsen J, , Rygaard J, , Fundova P, & Charabi B: Cystic vestibular schwannoma—clinical and experimental studies. Acta Otolaryngol Suppl 543:1113, 2000

    • Search Google Scholar
    • Export Citation
  • 7

    Chin KF, , Babar J, , Tzifa K, , Chavda SV, & Irving RM: Vestibular schwannomas with fluid-fluid level. J Laryngol Otol 121:902906, 2007

  • 8

    Couloigner V, , Gervaz E, , Kalamarides M, , Ferrary E, , Rey A, & Sterkers O, et al.: Clinical and histologic parameters correlated with facial nerve function after vestibular schwannoma surgery. Skull Base 13:1319, 2003

    • Search Google Scholar
    • Export Citation
  • 9

    de Ipolyi AR, , Yang I, , Buckley A, , Barbaro NM, , Cheung SW, & Parsa AT: Fluctuating response of a cystic vestibular schwannoma to radiosurgery: case report. Neurosurgery 62:E1164E1165, 2008

    • Search Google Scholar
    • Export Citation
  • 10

    Fundová P, , Charabi S, , Tos M, & Thomsen J: Cystic vestibular schwannoma: surgical outcome. J Laryngol Otol 114:935939, 2000

  • 11

    Ganslandt O, , Fahrig A, & Strauss C: Hemorrhage into cystic vestibular schwannoma following stereotactic radiation therapy. Zentralbl Neurochir 69:204206, 2008

    • Search Google Scholar
    • Export Citation
  • 12

    Gerganov VM, , Klinge PM, , Nouri M, , Stieglitz L, , Samii M, & Samii A: Prognostic clinical and radiological parameters for immediate facial nerve function following vestibular schwannoma surgery. Acta Neurochir (Wien) 151:581587, 2009

    • Search Google Scholar
    • Export Citation
  • 13

    Gomez-Brouchet A, , Delisle MB, , Cognard C, , Bonafe A, , Charlet JP, & Deguine O, et al.: Vestibular schwannomas: correlations between magnetic resonance imaging and histopathologic appearance. Otol Neurotol 22:7986, 2001

    • Search Google Scholar
    • Export Citation
  • 14

    Jones SE, , Baguley DM, & Moffat DA: Are facial nerve outcomes worse following surgery for cystic vestibular schwannoma?. Skull Base 17:281284, 2007

    • Search Google Scholar
    • Export Citation
  • 15

    Kameyama S, , Tanaka R, , Kawaguchi T, , Fukuda M, & Oyanagi K: Cystic acoustic neurinomas: studies of 14 cases. Acta Neurochir (Wien) 138:695699, 1996

    • Search Google Scholar
    • Export Citation
  • 16

    Kanzaki J, , Tos M, , Sanna M, , Moffat DA, , Monsell EM, & Berliner KI: New and modified reporting systems from the consensus meeting on systems for reporting results in vestibular schwannoma. Otol Neurotol 24:642649, 2003

    • Search Google Scholar
    • Export Citation
  • 17

    Lunardi P, , Missori P, , Mastronardi L, & Fortuna A: Cystic acoustic schwannomas. Acta Neurochir (Wien) 110:120123, 1991

  • 18

    Matthies C, & Samii M: Management of 1000 vestibular schwannomas (acoustic neuromas): clinical presentation. Neurosurgery 40:110, 1997

  • 19

    Matthies C, , Samii M, & Krebs S: Management of vestibular schwannomas (acoustic neuromas): radiological features in 202 cases—their value for diagnosis and their predictive importance. Neurosurgery 40:469482, 1997

    • Search Google Scholar
    • Export Citation
  • 20

    Mehrotra N, , Behari S, , Pal L, , Banerji D, , Sahu RN, & Jain VK: Giant vestibular schwannomas: focusing on the differences between the solid and the cystic variants. Br J Neurosurg 22:550556, 2008

    • Search Google Scholar
    • Export Citation
  • 21

    Moon KS, , Jung S, , Seo SK, , Jung TY, , Kim IY, & Ryu HH, et al.: Cystic vestibular schwannomas: a possible role of matrix metalloproteinase-2 in cyst development and unfavorable surgical outcome. J Neurosurg 106:866871, 2007

    • Search Google Scholar
    • Export Citation
  • 22

    Park CK, , Kim DC, , Park SH, , Kim JE, , Paek SH, & Kim DG, et al.: Microhemorrhage, a possible mechanism for cyst formation in vestibular schwannomas. J Neurosurg 105:576580, 2006

    • Search Google Scholar
    • Export Citation
  • 23

    Piccirillo E, , Wiet MR, , Flanagan S, , Dispenza F, , Giannuzzi A, & Mancini F, et al.: Cystic vestibular schwannoma: classification, management, and facial nerve outcomes. Otol Neurotol 30:826834, 2009

    • Search Google Scholar
    • Export Citation
  • 24

    Prasad S, , Gupta S, , Patankar T, & Goel A: Fluid-fluid levels in intracranial schwannomas. Australas Radiol 43:529531, 1999

  • 25

    Samii M, , Gerganov V, & Samii A: Improved preservation of hearing and facial nerve function in vestibular schwannoma surgery via the retrosigmoid approach in a series of 200 patients. J Neurosurg 105:527535, 2006

    • Search Google Scholar
    • Export Citation
  • 26

    Samii M, & Matthies C: Management of 1000 vestibular schwannomas (acoustic neuromas): surgical management and results with an emphasis on complications and how to avoid them. Neurosurgery 40:1123, 1997

    • Search Google Scholar
    • Export Citation
  • 27

    Sinha S, & Sharma BS: Cystic acoustic neuromas: surgical outcome in a series of 58 patients. J Clin Neurosci 15:511515, 2008

  • 28

    Sugihara S, , Kinoshita T, , Matsusue E, , Fujii S, & Ogawa T: Multicystic acoustic schwannoma with intratumoral hemorrhage: a report of two cases. Magn Reson Med Sci 3:101104, 2004

    • Search Google Scholar
    • Export Citation
  • 29

    Thamburaj K, , Radhakrishnan VV, , Thomas B, , Nair S, & Menon G: Intratumoral microhemorrhages on T2*-weighted gradientecho imaging helps differentiate vestibular schwannoma from meningioma. AJNR Am J Neuroradiol 29:552557, 2008

    • Search Google Scholar
    • Export Citation
  • 30

    Zaouche S, , Ionescu E, , Dubreuil C, & Ferber-Viart C: Pre- and intraoperative predictive factors of facial palsy in vestibular schwannoma surgery. Acta Otolaryngol 125:363369, 2005

    • Search Google Scholar
    • Export Citation

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