Cerebrospinal fluid leak after microsurgical surgery in vestibular schwannomas via retrosigmoidal craniotomy

Arlt, Felix; Trantakis, C.; Krupp, Wolfgang; Renner, C; Winkler, Dirk; Strauß, Gero; Meixensberger, Jürgen

doi:10.1179/1743132811y.0000000042

Cited by 37 publications

(34 citation statements)

References 27 publications

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“…The main observed complications of facial paralysis, headache, hearing loss, dizziness, and CSF leak in the surgical cohort are consistent with the common complications reported in the literature. 5,6,20-22…”

Section: Discussionmentioning

confidence: 99%

Risk Recall of Complications Associated with Vestibular Schwannoma Treatment

Goshtasbi

Abouzari

Moshtaghi

et al. 2019

Otolaryngol.--head neck surg.

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Objective To assess the risk recall of complications among patients who underwent different vestibular schwannoma (VS) treatments. Study Design Patients with VS completed a voluntary and anonymous survey. Setting Survey links were distributed via the Acoustic Neuroma Association (ANA) website, Facebook, and email list. Subjects and Methods Surveys were distributed to ANA members from January to March 2017. Of the 3200 ANA members with a VS diagnosis at the time of survey distribution, 789 (25%) completed the survey. Results Subjects reported the following incidence of posttreatment complications: imbalance (60%), hearing issues (51%), dry eyes (30%), headache (29%), and facial weakness (27%). Overall, 188 (25%) recalled remembering all the risks associated with their treatment. Among those in the surgical cohort (52%) who experienced balance issues, facial weakness, cerebrospinal fluid leak, meningitis, and stroke, 73%, 91%, 77%, 67%, and 33% claimed recall of these associated risks. Among those in the radiosurgery cohort (28%) who experienced balance issues, facial weakness, and hydrocephalus, 56%, 52%, and 60% recalled discussions of those risks. Patients with higher-level education ( P = .026) and those who underwent surgery ( P = .001) had a significantly higher risk recall ratio, while sex, age, and tumor size were not significant contributing factors. Conclusion Not all patients with VS who experienced treatment complications recalled remembering those risks being discussed with them. Patients with higher education and those who underwent surgery had a better recall of risks associated with different treatment modalities. The risk recall ratio of patients experiencing complications ranged 33% to 91%, suggesting an opportunity for decision-making and discussion improvement.

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Section: Discussionmentioning

confidence: 99%

Risk Recall of Complications Associated with Vestibular Schwannoma Treatment

Goshtasbi

Abouzari

Moshtaghi

et al. 2019

Otolaryngol.--head neck surg.

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“…In the present study the combination of those techniques, as it is in the sandwich technique, reduces the CSF leakage complication rate to 3.8% (only 0.5% needed a surgical revision) which is low compared to the complication rate described in the literature. 3 , 6 , 7 …”

Section: Discussionmentioning

confidence: 99%

“…The 0.5% of patients needed a second surgery for CSF leakage closure which is better compared to 3.7% in a similar study. 7 The rest of the patients with CSF leakage were managed by a lumbar drain for 5-7 days. The 2% of the patients had cerebellar bleeding with no need of re-operation and 3% had a wound infection treated with antibiotics to good effect.…”

Section: Discussionmentioning

confidence: 99%

Sandwich Wound Closure Reduces the Risk of Cerebrospinal Fluid Leaks in Posterior Fossa Surgery

Heymanns

Oseni

Alyeldien

et al. 2016

Clinics and Practice

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Posterior fossa surgery is demanding and hides a significant number of obstacles starting from the approach to the wound closure. The risk of cerebrospinal fluid (CSF) leakage in posterior fossa surgery given in the literature is around 8%. The present study aims to introduce a sandwich closure of the dura in posterior fossa surgery, which reduces significantly the number of CSF leaks (3.8%) in the patients treated in our department. Three hundred and ten patients treated in our hospital in the years 2009-2013 for posterior fossa pathologies were retrospectively evaluated. The dura closure method was as following: lyophilized dura put under the dura and sealed with fibrin glue and sutures, dura adapting stitches, TachoSil® (Takeda Pharma A/S, Roskilde, Denmark), Gelfoam® (Pfizer Inc., New York, NY, USA) and polymethylmethacrylate (osteoclastic craniotomy). The incidence of postsurgical complications associated with the dural closure like CSF leakage, infections, bleeding is evaluated. Only 3.8% of patients developed CSF leakage and only 0.5% needed a second surgery for CSF leakage closure. Two percent had a cerebellar bleeding with no need for re-operation and 3% had a wound infection treated with antibiotics. The sandwich wound closure we are applying for posterior fossa surgery in our patients correlates with a significant reduction of CSF leaks compared to the literature.

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“… 8 The cause of hydrocephalus was considered a combination of cerebrospinal fluid (CSF) overproduction (four to five times that in healthy persons), obstruction of CSF pathways by the tumor mass, impaired CSF absorption, increased protein content of CSF around the tumor, subarachnoid scarring or granulations related to recurrent bleeding from the tumor, elevated intraventricular pulse pressure, and adhesions around the exit foramina of the fourth ventricle caused by highly proteinaceous or hemorrhagic CSF. 2 10 18 The finding of tumor calcification in the CPA generally required consideration of differential diagnosis with papillary or psammomatous meningioma, melanotic schwannoma, and myxopapillary ependymoma. Among these tumors, association of ventricular enlargement with the finding of calcification might suggest the possible presence of CPTs.…”

Section: Discussionmentioning

confidence: 99%

“…Among CPTs, the atypical CPP occupied in the rate of 37%. Total removal of CPTs is recommended and seems to be feasible since a significant prognostic factor was relevant to the extent of tumor removal, and no definitive evidence of the beneficial effect of radiotherapy has been reported 6 18 19 20 . However, it is not always possible because of tumor bleeding and firm adhesion to adjacent structures, especially cranial nerves.…”

Section: Discussionmentioning

confidence: 99%

Densely Calcified Atypical Choroid Plexus Papilloma at the Cerebellopontine Angle in an Adult

Wanibuchi¹,

Margraf²,

Fukushima

2013

J Neurol Surg Rep

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Choroid plexus papilloma is a rare benign tumor accounting for 0.5% of all intracranial tumors. The majority of choroid plexus papillomas occur during the first 2 years of life in the ventricular system. Moreover, dense calcification of the tumor is uncommon. We report an adult case of densely calcified, atypical choroid plexus papilloma that originated from the cerebellopontine angle without connection to the forth ventricle. Because the case involves a rare combination of four features—adult, dense calcification, atypical form, and cerebellopontine angle—each characteristic associated with the choroid plexus papilloma was discussed. The finding of calcification at the cerebellopontine angle in an adult should suggest the possible presence of choroid plexus papilloma.

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Cerebrospinal fluid leak after microsurgical surgery in vestibular schwannomas via retrosigmoidal craniotomy

Abstract: Suture and occlusion of the dura is an important step to prevent CSF leak and postoperative infection. By comparing sandwich technique and single-layer dural sealing, no significant difference could be shown.

Cited by 37 publications

References 27 publications

Risk Recall of Complications Associated with Vestibular Schwannoma Treatment

Risk Recall of Complications Associated with Vestibular Schwannoma Treatment

Sandwich Wound Closure Reduces the Risk of Cerebrospinal Fluid Leaks in Posterior Fossa Surgery

Densely Calcified Atypical Choroid Plexus Papilloma at the Cerebellopontine Angle in an Adult

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