Background:Cerebrospinal fluid (CSF) leakages represent a major complication of skull base surgery. Watertight dural suture is challenging, and different ways to reinforce it have been proposed. Since 6 months, we use locally harvested autologous pericranium graft for dural repair in retrosigmoid approach.Methods:Retrospectively, we analyzed 27 patients operated on with key-hole retrosigmoid approach from May 2014. In all, autologous pericranium was harvested and inserted as an underlay “hourglass-shaped” plug under the dura plane and stitched to dura. Surgical patch and sealant were used for augmentation. Complications considered were new neurological symptoms, surgical site infections, meningitis, CSF-leaks, and pseudomeningocele.Results:Indications included tumor (16 cases), microvascular decompression (10 cases), and hemorrhagic cerebellar arteriovenous malformation (1 case). Surgical site infections, meningitis, and CSF leaks have never been observed. One neurofibromatosis type 2 patient operated on for large acoustic neuroma developed an asymptomatic pseudomeningocele, disappeared on 3-month magnetic resonance imaging follow-up.Conclusions:In our series, autologous pericranium inserted and stitched as an underlay hourglass-shaped plug, augmented with surgical patch pieces and dural sealant seemed to be safe and effective for dural repair in “key-hole” retrosigmoid approach. With this technique, we obtained low complication rate, similar to the best current results of available literature.

No abstract

No abstract

No abstract

No abstract

Cavernous angiomas originating in the internal auditory canal are very rare. In the available literature, only 65 cases of cavernomas in this location have been previously reported. We describe the case of a 22-year-old woman surgically treated for a cavernous hemangioma in the left internal auditory canal, mimicking on preoperative magnetic resonance imaging MRI an acoustic neuroma. Neurological symptoms were hypoacusia and dizziness. The cavernous angioma encased the seventh and, partially, the eighth cranial nerve complex. A "nearly total" removal was performed, leaving a thin residual of malformation adherent to the facial nerve. Postoperative period was uneventful; hearing was unchanged, but the patient had a moderate inferior left facial palsy (House-Brackmann grade II) slightly improved during the following weeks. On the basis of the observation of this uncommon case, we propose a revision of the literature and discuss clinical features, differential diagnosis, and treatment.

Background: In 10-15% of cases of vestibular schwannoma (VS) age at diagnosis is 40 years or less.Little is known about the differences in natural history, surgical ndings and postoperative outcomes of such younger patients as compared to those of greater age. Objectives : To analyze clinical and surgical and imaging data of a consecutive series of n=50 patients with unilateral sporadic VS, aged 40 years or younger -separated in a very young group (15-30 years) and a moderately young group (31-40 years). Study design: Retrospective case series Methods: 50 consecutive patients under 40 years of age underwent microsurgical resection of unilateral sporadic VS via the retrosigmoid approach. The study cohort was subdivided into two groups according to the age range: Group A, age range 15-30 years (n=23 patients) and Group B, age range 31-40 years (n=27 patients). The adherence of VS capsule to surrounding nervous structures and the tendency of the tumors to bleed were evaluated by reviewing video records; the course of the FN in relation to the tumor's surface was assessed in each case. Microsurgical removal of tumor was classi ed as total (T), near total (residual tumor volume <5%), subtotal (residual tumor volume 5-10%) or partial (residual tumor volume >10%).Results: Mean tumor size of entire cohort was 2,53 (range: 0,6-5,8) cm: 2,84 cm in Group A and 2,36 cm in Group B (p=NS). Facial nerve course and position within the cerebellopontine angle did not differ signi cantly between the two groups. At 6-month follow-up, FN functional outcome was: HBI-II in 69,5% in Group A, versus 96,3% in Group B (p<,001). Hearing preservation was achieved in 60,0% of patients of Group A and in 58,3% of Group B (p=NS). Total and near-total resection was feasible in 95,6% of cases of Group A and in 88,9% of Group B (p=NS). Tumor capsule was tightly adherent to nervous structures in 69,6% patients of Group A and in 22,2% of Group B (p<,05). Signi cant bleeding was encountered in 56,5% of Group A tumors, and in 29,6% of Group B tumors (p<,01).Conclusions: Microsurgery of VS in patients aged 40 or less is associated with good functional results, and with high rates of total and near total tumor removal. Patients <30 years of age have more adherent tumor capsules. Furthermore, their tumors exhibit a tendency to larger sizes, to hypervascularization, to profuse intraoperative bleeding and they present worse long-term functional FN results when compared to patients in their fourth decade of life. Our limited experience seems to suggest that a near total resection in very young VS patients with large tumors should be preferred in adherent and hypervascularized cases, in order to maximize resection and preserve function.

PurposeKoos Grade IV vestibular schwannomas (VS) (maximum diameter >3cm) compress the brainstem and displace the fourth ventricle. Microsurgical resection with attention to the right balance between preservation of function and maximal tumour removal is the treatment of choice. MethodsOur series consists of 60 consecutive patients with unilateral VS, operated on from December 2010 to July 2019. All patients underwent microsurgical removal via the retrosigmoid approach. The adherence of VS' capsule to surrounding nervous structures and the excessive tendency of tumor to bleed during debulking, because of a redundant vascular architecture, was evaluated by reviewing video records.Microsurgical removal of tumor was classi ed as total (T), near-total (NT: residue<5%), subtotal (ST: residue 5-10%) or partial (P: residue>10%). ResultsMaximal mean tumor diameter was 3,97cm (SD±1,13; range 3,1-5,8cm). Preoperative severely impaired hearing or deafness (AAO-HNS Classes C-D) was present in 52 cases (86,7%). Total or NT resection was accomplished in 46 cases (76,7%), 65,8% in cases with and 95,4% without tight adhesion of capsule to nervous structures (p<0,001). Endoscopic-assisted microsurgical removal of VS in the IAC was performed in 23 patients: in these cases a T resection was obtained in 78,3% versus 45,9% of microsurgery only (p<0,001).The capsule of VS was tightly adherent to nervous structures in 63,3% of patients, whereas hypervascular high-bleeding tumors represented 56,7%. Hearing preservation was possible in 2 out of 8 patients with preoperative class B hearing. At last follow-up, 34 patients (56,7%) had a normal postoperative FN outcome (HBI), 9 (15,0%) were HBII, 8 (13,3%) HBIII, and 9 (15,0%) HBIV. Total-NT resection of solid and low-bleeding VS, without tight capsule adhesion was associated with better FN outcome. Mortality was zero; permanent complications were observed in 2 cases (diplopia, hydrocephalus), transient in 9. ConclusionsMicrosurgery of Koos Grade IV VS seems to be associated with more than acceptable functional results, with high rate of T and NT removal of tumor. Long-term FN results seem to be worse in patients with cystic Koos Grade IV VS, in cases with tight capsule adherences to nervous structures and in highbleeding tumors.