Stereotactic radiosurgery and vestibular schwannoma: hydrocephalus associated with the development of a secondary arachnoid cyst: a report of two cases and review of the literature.

Stereotactic radiosurgery for vesibular schwannoma requires long-term follow-up with complete MR imaging. We report two cases of a large secondary arachnoid cyst developing in the cerebellopontine angle following stereotactic radiosurgery. In one case this was associated with progressive ventriculomegaly and the onset of symptomatic hydrocephalus requiring emergency treatment. The second patient had ventriculomegaly at diagnosis, but developed an arachnoid cyst following treatment. Although both arachnoid cysts and hydrocephalus may also occur spontaneously in patients with vestibular schwanomma, the incidence is higher after stereotactic radiosurgery. As both complications may be associated with sudden clinical deterioration, follow-up with full cranial T1 and T2 weighted MR imaging is required to reveal these complications, in addition to assessing tumour response.