neurosurgeryНейрохирургияRussian journal of neurosurgery1683-32952587-7569Издательский дом "МедИНК"10.63769/1683-3295-2025-27-4-66-73neurosurgery-1759Research ArticleНАБЛЮДЕНИЕ ИЗ ПРАКТИКИFROM PRACTICEХирургическое лечение многоуровневых нарушений ликвородинамики на примере клинического случаяSurgical treatment of multilevel disorders of cerebrospinal fluid dynamics on the example of a clinical casehttps://orcid.org/0000-0003-3732-6664ШевченкоК. В.ShevchenkoK. V.

Кирилл Викторович Шевченко

125047 Москва, ул. 4‑я Тверская-Ямская, 16

Kirill Victorovich Shevchenko

16 4th Tverskaya-Yamskaya St., Moscow 125047

kshevchenko@nsi.ruhttps://orcid.org/0000-0002-3816-847XШиманскийВ. Н.ShimanskyV. N.

125047 Москва, ул. 4‑я Тверская-Ямская, 16

16 4th Tverskaya-Yamskaya St., Moscow 125047

https://orcid.org/0000-0001-8351-5074ТаняшинС. В.TanyashinS. V.

125047 Москва, ул. 4‑я Тверская-Ямская, 16

16 4th Tverskaya-Yamskaya St., Moscow 125047

https://orcid.org/0000-0002-3447-0241ОдамановД. А.OdamanovD. A.

143442 Московская обл., Красногорск, п. Отрадное, влд. 2, стр. 1

Bld. 1, Vld. 2 Otradnoye, Krasnogorsk, Moscow Region 143442

https://orcid.org/0000-0001-8542-0060КугушевИ. О.KugushevI. O.

125047 Москва, ул. 4‑я Тверская-Ямская, 16

16 4th Tverskaya-Yamskaya St., Moscow 125047

ФГАУ «Национальный медицинский исследовательский центр нейрохирургии им. акад. Н. Н. Бурденко» Минздрава РоссииРоссияN.N. Burdenko National Medical Research Center of Neurosurgery, Ministry of Health of RussiaRussian FederationКлиническая больница в Отрадном № 1 АО «Группа компаний МЕДСИ»РоссияOtradnoye Clinical Hospital № 1, MEDSI Group of CompaniesRussian Federation2025150120262746673Copyright © Шевченко К.В., Шиманский В.Н., Таняшин С.В., Одаманов Д.А., Кугушев И.О., 20262026Шевченко К.В., Шиманский В.Н., Таняшин С.В., Одаманов Д.А., Кугушев И.О.Shevchenko K.V., Shimansky V.N., Tanyashin S.V., Odamanov D.A., Kugushev I.O.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.therjn.com/jour/article/view/1759

Невринома слухового нерва – доброкачественная опухоль оболочки вестибулокохлеарного нерва. Чаще заболевание диагностируют у пациентов трудоспособного возраста. Опухоли подлежат хирургическому или лучевому лечению, которые имеют примерно одинаковую эффективность. Необходимыми условиями для проведения лучевого лечения являются отсутствие кист в строме опухоли и компрессии ствола мозга, а также гидроцефалии и вклинения миндалин мозжечка в большое затылочное отверстие. Наличие гидроцефалии и вклинения миндалин требует хирургической коррекции перед проведением лучевого лечения путем ликворошунтирующей операции и декомпрессии краниовертебрального перехода. При сочетании малых размеров невриномы и гидроцефалии, не связанной с опухолью, возможна коррекция ликвородинамических нарушений путем малоинвазивных операций. В статье представлен случай успешного лечения пациентки с многоуровневой обструкцией ликворных путей малоинвазивным методом в качестве превентивного перед проведением стереотаксического облучения невриномы слухового нерва.

Acoustic neuroma is a benign tumor of the shelf of vestibulocochlear nerve. More often, the disease is diagnosed on working age. Tumors are subject surgical treatment or stereotaxic radiosurgery both have approximately the same efficiency. Principal conditions for radiosurgery are absence of the cysts and brainstem compression, hydrocephalus and tonsils herniation. Hydrocephalus and tonsils herniation are subject to surgical treatment be shunt-surgery and decompression craniovertebral junction before radiological treatment. Combination small acoustic neuroma and non-tumor caused hydrocephalus is allowed to use mini-invasive surgery. The article presents successful endoscopic surgery of the patient with multiple cerebrospinal fluid obstruction before stereotaxic radiosurgery of acoustic neuroma.

гидроцефалияобструкция отверстия Монрофораминопластикаобструкция выходных отверстий IV желудочкаэндоскопическая тривентрикулостомияневринома слухового нерва (вестибулярная шваннома)мальформация Киариhydrocephalusforamina Monroe obstructionforaminoplastyobstruction of the 4th ventricle outletsendoscopic third ventriculostomyacoustic neuroma (vestibular schwannoma)Chiari malformationReferencesAbel N.A. Handbook of neurosurgery. 7th edn. New York: Thieme Medical Publishers, 2010. 1337 p.Abel N.A. Handbook of neurosurgery. 7th edn. New York: Thieme Medical Publishers, 2010. 1337 p.Шиманский В.Н., Таняшин С.В., Шевченко К.В., Одаманов Д.А. Хирургическое лечение неврином слухового нерва (вестибулярных шванном). Журнал «Вопросы нейрохирургии» им. Н.Н. Бурденко 2017;81(3):66–76. DOI: 10.17116/neiro201781366-76Shimansky V.N., Tanyashin S.V., Shevchenko K.V., Odamanov D.A. Surgical treatment of acoustic neuromas (vestibular schwannomas). Zhurnal Voprosy neirochirurgii im. N.N. Burdenko = Burdenko’s Journal of Neurosurgery 2017;81(3):66–76. (In Russ). DOI: 10.17116/neiro201781366-76Sughrue M., Yang I., Aranda D. et al. Beyond audiofacial morbidity after vestibular schwannoma surgery. J Neurosurg 2011;114(2): 367–74. DOI: 10.3171/2009.10.JNS091203Sughrue M., Yang I., Aranda D. et al. Beyond audiofacial morbidity after vestibular schwannoma surgery. J Neurosurg 2011;114(2): 367–74. DOI: 10.3171/2009.10.JNS091203Koos W., Lang J., Matula C. et al. Color atlas of microneurosurgery of acoustic neurinomas. Stuttgart, New York: Thieme, 2002.Koos W., Lang J., Matula C. et al. Color atlas of microneurosurgery of acoustic neurinomas. Stuttgart, New York: Thieme, 2002.Samii M., Matthies C. Management of 1000 vestibular schwannomas (acoustic neuromas): hearing function in 1000 tumor resections. Neurosurgery 1997;40(2):248–60. DOI: 10.1097/00006123-199702000-00005Samii M., Matthies C. Management of 1000 vestibular schwannomas (acoustic neuromas): hearing function in 1000 tumor resections. Neurosurgery 1997;40(2):248–60. DOI: 10.1097/00006123-199702000-00005Samii 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 1997;40(1):11–21. DOI: 10.1097/00006123-199701000-00002Samii 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 1997;40(1):11–21. DOI: 10.1097/00006123-199701000-00002Gardner W.J., Spitler D.K., Whitten C. Increased intracranial pressure caused by increased protein content in the cerebrospinal fluid; an explanation of papilledema in certain cases of small intracranial and intraspinal tumors, and in the Guillain–Barre syndrome. N Engl J Med 1954;250(2):932–6. DOI: 10.1056/NEJM195406032502202Gardner W.J., Spitler D.K., Whitten C. Increased intracranial pressure caused by increased protein content in the cerebrospinal fluid; an explanation of papilledema in certain cases of small intracranial and intraspinal tumors, and in the Guillain–Barre syndrome. N Engl J Med 1954;250(2):932–6. DOI: 10.1056/NEJM195406032502202Jeon C.J., Kong D.S., Nam D.H. et al. Communicating hydrocephalus associated with surgery or radiosurgery for vestibular schwannoma. J Clin Neurosci 2010;17(7):862–4. DOI: 1016/j.jocn.2009.12.004Jeon C.J., Kong D.S., Nam D.H. et al. Communicating hydrocephalus associated with surgery or radiosurgery for vestibular schwannoma. J Clin Neurosci 2010;17(7):862–4. DOI: 1016/j.jocn.2009.12.004Steenerson R.L., Payne N. Hydrocephalus in the patient with acoustic neuroma. Otolaryngol Head Neck Surg 1992;107(1):35–9. DOI: 10.1177/019459989210700106Steenerson R.L., Payne N. Hydrocephalus in the patient with acoustic neuroma. Otolaryngol Head Neck Surg 1992;107(1):35–9. DOI: 10.1177/019459989210700106Nakahara M., Imahori T., Sasayama T. et al. Refractory communicating hydrocephalus after radiation for small vestibular schwannoma with asymptomatic ventriculomegaly: a case report. Radiol Case Rep 2020;15(7):1023–8. DOI: 10.1016/j.radcr.2020.04.063Nakahara M., Imahori T., Sasayama T. et al. Refractory communicating hydrocephalus after radiation for small vestibular schwannoma with asymptomatic ventriculomegaly: a case report. Radiol Case Rep 2020;15(7):1023–8. DOI: 10.1016/j.radcr.2020.04.063Taniguchi M., Nakai T., Kohta M. et al. Communicating hydrocephalus associated with small-to-medium-sized vestibular schwannomas: clinical significance of the tumor apparent diffusion coefficient map. World Neurosurg 2016;94:261–7. DOI: 10.1016/j.wneu.2016.07.012Taniguchi M., Nakai T., Kohta M. et al. Communicating hydrocephalus associated with small-to-medium-sized vestibular schwannomas: clinical significance of the tumor apparent diffusion coefficient map. World Neurosurg 2016;94:261–7. DOI: 10.1016/j.wneu.2016.07.012Frischer J.M., Gruber E., Schöffmann V. et al. Long-term outcome after Gamma Knife radiosurgery for acoustic neuroma of all Koos grades: a single-center study. J Neurosurg 2018;130(2):388–97. DOI: 10.3171/2017.8.JNS171281Frischer J.M., Gruber E., Schöffmann V. et al. Long-term outcome after Gamma Knife radiosurgery for acoustic neuroma of all Koos grades: a single-center study. J Neurosurg 2018;130(2):388–97. DOI: 10.3171/2017.8.JNS171281Al Hinai Q., Zeitouni A., Sirhan D. et al. Communicating hydrocephalus and vestibular schwannomas: etiology, treatment, and long-term follow-up. J Neurol Surg B Skull Base 2013;74(2):68–74. DOI: 10.1055/s-0033-1333621Al Hinai Q., Zeitouni A., Sirhan D. et al. Communicating hydrocephalus and vestibular schwannomas: etiology, treatment, and long-term follow-up. J Neurol Surg B Skull Base 2013;74(2):68–74. DOI: 10.1055/s-0033-1333621Шевченко К.В., Шиманский В.Н., Таняшин С.В. и др. Идиопатическая гидроцефалия взрослых: современное состояние проблемы. Сибирское медицинское обозрение 2021;(1):20–33. DOI: 10.20333/2500136-2021-1-20-33Shevchenko K.V., Shimansky V.N., Tanyashin S.V. et al. Adult idiopathic hydrocephalus: current state of the problem. Sibirskoe meditsinskoye obozreniye = Siberian Medical Review 2021;(1): 20–33. (In Russ.). DOI: 10.20333/2500136-2021-1-20-33Mizrahi C.J., Cohen J.E., Gomori J.M. et al. Idiopathic bilateral occlusion of the foramen of Monro: an unusual entity with varied clinical presentations. J Clin Neurosci 2016;34:140–4. DOI: 10.1016/j.jocn.2016.05.015Mizrahi C.J., Cohen J.E., Gomori J.M. et al. Idiopathic bilateral occlusion of the foramen of Monro: an unusual entity with varied clinical presentations. J Clin Neurosci 2016;34:140–4. DOI: 10.1016/j.jocn.2016.05.015Cinalli G., Spennato P., Nastro A. et al. Hydrocephalus in aqueductal stenosis. Childs Nerv Syst 2011;27(10):1621–42. DOI: 10.1007/s00381-011-1546-2Cinalli G., Spennato P., Nastro A. et al. Hydrocephalus in aqueductal stenosis. Childs Nerv Syst 2011;27(10):1621–42. DOI: 10.1007/s00381-011-1546-2Brunelle F. Modern imaging of hydrocephalus. In: Pediatric hydrocephalus. Ed. by G. Cinalli, Ch. Sainte-Rose, W.J. Maixner et al. Springer-Verlag Italia, 2005. Pp. 79–93.Brunelle F. Modern imaging of hydrocephalus. In: Pediatric hydrocephalus. Ed. by G. Cinalli, Ch. Sainte-Rose, W.J. Maixner et al. Springer-Verlag Italia, 2005. Pp. 79–93.Bai J., Yu Q., Sun X. et al. Hydrocephalus due to idiopathic fourth ventricle outflow obstruction. J Craniofac Surg 2019;30(5):397–400. DOI: 10.1097/SCS.0000000000005314Bai J., Yu Q., Sun X. et al. Hydrocephalus due to idiopathic fourth ventricle outflow obstruction. J Craniofac Surg 2019;30(5):397–400. DOI: 10.1097/SCS.0000000000005314Panero I., García-Pérez D., Lagares A. Positive outcome of endoscopic third ventriculostomy in fouth ventricular outlet obstruction. World Neurosurg 2019;132:135–7. DOI: 10.1016/j.wneu.2019.08.164Panero I., García-Pérez D., Lagares A. Positive outcome of endoscopic third ventriculostomy in fouth ventricular outlet obstruction. World Neurosurg 2019;132:135–7. DOI: 10.1016/j.wneu.2019.08.164Shimoda Y., Murakami K., Narita N., Tominaga T. Fourth ventricle outlet obstruction with expanding space on the surface of cerebellum. World Neurosurg 2017;100:711.e1–e5. DOI: 10.1016/j.wneu.2017.01.088Shimoda Y., Murakami K., Narita N., Tominaga T. Fourth ventricle outlet obstruction with expanding space on the surface of cerebellum. World Neurosurg 2017;100:711.e1–e5. DOI: 10.1016/j.wneu.2017.01.088Gerganov V.M., Pirayesh A., Nouri M. et al. Hydrocephalus associated with vestibular schwannomas: management options and factors predicting the outcome. J Neurosurg 2011;114(5): 1209–15. DOI: 10.3171/2010.10.JNS1029Gerganov V.M., Pirayesh A., Nouri M. et al. Hydrocephalus associated with vestibular schwannomas: management options and factors predicting the outcome. J Neurosurg 2011;114(5): 1209–15. DOI: 10.3171/2010.10.JNS1029Tanaka Y., Kobayashi S., H ongo K. et al. Clinical and neuroimaging characteristics of hydrocephalus associated with vestibular schwannoma. J Neurosurg 2003;98(6):1188–93. DOI: 10.3171/jns.2003.98.6.1188Tanaka Y., Kobayashi S., H ongo K. et al. Clinical and neuroimaging characteristics of hydrocephalus associated with vestibular schwannoma. J Neurosurg 2003;98(6):1188–93. DOI: 10.3171/jns.2003.98.6.1188Шиманский В.Н., Карнаухов В.В., Галкин М.В. и др. Лечение петрокливальных менингиом: современное состояние проблемы. Журнал «Вопросы нейрохирургии» им. Н.Н. Бурденко 2019;83(6):78–89. DOI: 10.17116/neiro20198306178Shimansky V.N., Karnaukhov V.V., Galkin M.V. et al. Treatment of petroclival meningiomas: current state of the problem. Zhurnal Voprosy neirokhirurgii im. N.N. Burdenko = Burdenko’s Journal of Neurosurgery 2019;83(6):78–89. (In Russ.). DOI: 10.17116/neiro20198306178Карнаухов В.В., Галкин М.В., Султанов Р.А. и др. Использование кистоцистерального стентирования в комбинированном лечении пациентки с гигантской петрокливальной менингиомой (описание клинического случая). Российский нейрохирургический журнал им. проф. А.Л. Поленова 2022;14(1–1): 132–6.Karnaukhov V.V., Galkin M.V., Sultanov R.A. et al. Сystocysternal stenting implementation in combined treatment of a giant petroclival meningioma. Rossiyskiy neyrokhirurgicheskiy zhurnal im. prof. A.L. Polenova = The Russian Neurosurgical Journal n. a. prof. A.L. Polenov 2022;14(1–1):132–6. (In Russ.).Shapiro R., Galloway S.J., Shapiro M.D. Minimal asymmetry of the brain: a normal variant. Am J Roentgenol 1986;147(4):753–6. DOI: 10.2214/ajr.147.4.753Shapiro R., Galloway S.J., Shapiro M.D. Minimal asymmetry of the brain: a normal variant. Am J Roentgenol 1986;147(4):753–6. DOI: 10.2214/ajr.147.4.753Ishi Y., Asaoka K., Kobayashi H. et al. Idiopathic fourth ventricle outlet obstruction successfully treated by endoscopic third ventriculostomy: a case report. Springer Plus 2015;30(4):565. DOI: 10.1186/s40064-015-1368-xIshi Y., Asaoka K., Kobayashi H. et al. Idiopathic fourth ventricle outlet obstruction successfully treated by endoscopic third ventriculostomy: a case report. Springer Plus 2015;30(4):565. DOI: 10.1186/s40064-015-1368-xKarachi C., Le Guérinel C., Brugières P. et al. Hydrocephalus due to idiopathic stenosis of the foramina of Magendie and Luschka. Report of three cases. J Neurosurg 2003;98(4):897–902. DOI: 10.3171/jns.2003.98.4.0897Karachi C., Le Guérinel C., Brugières P. et al. Hydrocephalus due to idiopathic stenosis of the foramina of Magendie and Luschka. Report of three cases. J Neurosurg 2003;98(4):897–902. DOI: 10.3171/jns.2003.98.4.0897Longatti P., Fiorindi A., Martinuzzi A., Feletti A. Primary obstruction of the fourth ventricle outlets: neuroendoscopiс approach and anatomic description. Neurosurgery 2009;65(6):1078–85; discussion 1085–6. DOI: 10.1227/01.NEU.0000360133.29217.44Longatti P., Fiorindi A., Martinuzzi A., Feletti A. Primary obstruction of the fourth ventricle outlets: neuroendoscopiс approach and anatomic description. Neurosurgery 2009;65(6):1078–85; discussion 1085–6. DOI: 10.1227/01.NEU.0000360133.29217.44Mohanty A., Biswas A., Satish S., Vollmer D.G. Efficacy of endoscopic third ventriculostomy in fourth ventricular outlet obstruction. Neurosurgery 2008;63(5):905–13; discussion 913–4. DOI: 10.1227/01.NEU.0000333262.38548.E1Mohanty A., Biswas A., Satish S., Vollmer D.G. Efficacy of endoscopic third ventriculostomy in fourth ventricular outlet obstruction. Neurosurgery 2008;63(5):905–13; discussion 913–4. DOI: 10.1227/01.NEU.0000333262.38548.E1

The authors declare that there are no conflicts of interest present.