Cerebrospinal fluid leak after translabyrinthine acoustic neuroma surgery

Celikkanat, Serdar; Saleh, Essam; Khashaba, Ahmad; Taibah, Abdelkader; Russo, Alessandra; Mazzoni, Antonio; Sanna, Mario

doi:10.1016/s0194-5998(95)70171-0

Cited by 28 publications

(17 citation statements)

References 11 publications

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“…Patients with highly pneumatized petrous bone have a higher risk of CSF rhinorrhea. 2,7,19) This study analyzed thin-slice bone-window computed tomography (CT) of 168 petrous bones in 84 patients to clarify the anatomy of the air cells in the petrous bone.…”

Section: Introductionmentioning

confidence: 99%

Computed Tomography Evaluation of Air Cells in the Petrous Bone-Relationship With Postoperative Cerebrospinal Fluid Rhinorrhea-

Yamakami

Uchino

Kobayashi

et al. 2003

Neurol. Med. Chir.(Tokyo)

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The anatomy of air cells in the petrous bone was investigated using thin-slice bone-window computed tomography (CT) of 168 petrous bones in 84 patients. Air cells in the petrous bone were classified into mastoid and petrous cells. Petrous cells were subdivided into perilabyrinthine and apical cells. Perilabyrinthine cells comprised supralabyrinthine and infralabyrinthine cells. Supralabyrinthine cells were subdivided into posterosuperior, posteromedial, and subarcuate cells. The mastoid was classified as eburnated (11%) or pneumatized (89%) by the extent of the mastoid cells. The mastoid cells were classified into presinusoidal (14%), sinusoidal (44%), and postsinusoidal (42%) according to the relationship with the sigmoid sulcus. The extent of the mastoid cells was significantly correlated with the pneumatization of the petrous apex, i.e. the apical cells (p º 0.01). CT precisely depicted the complex anatomy of the air cells in the petrous bone. Cerebrospinal fluid (CSF) rhinorrhea is the most common complication after skull base surgery for cerebellopontine angle tumors. Air cells in the petrous bone provide the route for CSF rhinorrhea. Therefore, CT assessment of the air cells is useful for preventing this complication.

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Section: Introductionmentioning

confidence: 99%

Computed Tomography Evaluation of Air Cells in the Petrous Bone-Relationship With Postoperative Cerebrospinal Fluid Rhinorrhea-

Yamakami

Uchino

Kobayashi

et al. 2003

Neurol. Med. Chir.(Tokyo)

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“…Surgical complications not directly involving facial nerve function included cerebrospinal fluid leak requiring surgical correction in 6 patients (5%), comparable to literature reports of between 6 and 16%. [9][10][11][12] There was no incidence of stroke, trigeminal or abducens nerve injury, or death. None of the patients suffered intraoperative anatomic discontinuity of the facial nerve.…”

Section: Resultsmentioning

confidence: 98%

“…8 Such protection does not remove the potential for injury to the facial nerve during mastoid drilling, or by direct trauma against the posterior petrous bone during surgical manipulation. Furthermore, a high incidence of cerebrospinal fluid (CSF) leak following translabyrinthine approach for acoustic neuroma resection has been reported, [9][10][11][12] predisposing patients to complications of meningitis and intracranial hypotension.…”

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confidence: 99%

Clinical predictors of facial nerve outcome after translabyrinthine resection of acoustic neuromas

Shamji¹,

Schramm²,

Benoit³

2007

CIM

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Clin Invest Med 2007; 30 (6): E233-E239. AbstractPurpose: The translabyrinthine approach to acoustic neuroma resection offers excellent exposure for facial nerve dissection with 95% preservation of anatomic continuity. Acceptable outcome in facial asymptomatic patients is reported at 64-90%, but transient postoperative deterioration often occurs. The objective of this study was to identify preoperative clinical presentation and intraoperative surgical findings that predispose patients to facial nerve dysfunction after acoustic neuroma surgery. Methods: The charts of 128 consecutive translabyrinthine patients were examined retrospectively to identify new clinical and intraoperative predictors of facial nerve outcome. Postoperative evaluation of patients to normal function or mild asymmetry upon close inspection (HouseBrackmann grades of I or II) was defined as an acceptable outcome, with obvious asymmetry to no movement (grades III to VI) defined as unacceptable. Intraoperative nerve stimulation was performed in all cases, and clinical grading was performed by a single neurosurgeon in all cases. Results: Among patients with no preoperative facial nerve deficit, 87% had an acceptable result. Small size (P < 0.01) and low intraoperative nerve stimulation of < 0.10 mA (P< 0.01) were reaffirmed as predictive of functional nerve preservation. Additionally, preoperative tinnitus (P = 0.03), short duration of hearing loss (P< 0. 01), and lack of subjective tumour adherence to the facial nerve (P = 0.02) were independently correlated with positive outcome. Conclusions: Our experience with the translabyrinthine approach reveals the previously unestablished associations of facial nerve outcome to include presence of tinnitus and duration of hypoacusis. Independent predictors of tumour size and nerve stimulation thresholds were reaffirmed, and the subjective description of tumour adherence to the facial nerve making dissection more difficult appears to be important.Surgery for the treatment of acoustic neuroma has undergone a paradigm shift from the early twentieth century when it was regarded as a life-saving intervention for what was often a large lesion. Cushing 1 and Dandy 2 initially described subtotal and gross-total removal of such acoustic neuromas respectively, but the advent of precise neuroimaging and the operating microscope

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“…[29][30][31][32][33]36,40,44 To prevent postoperative CSF leaks after TLAN, several surgical methods have been tried, using different autografts and allografts, alone or in combinations, with varying success rates. 6,8,10,11,13,[22][23][24]27,28,42,46 These range from calvarial bone autografts, bone cements, metals, and resins to resorbable bone plates. 5,6,51 Calvarial grafts can be time consuming and less malleaPrevention of postoperative cerebrospinal fluid leaks with multilayered reconstruction using titanium mesh-hydroxyapatite cement cranioplasty after translabyrinthine resection of acoustic neuroma Object.…”

mentioning

confidence: 99%

Prevention of postoperative cerebrospinal fluid leaks with multilayered reconstruction using titanium mesh–hydroxyapatite cement cranioplasty after translabyrinthine resection of acoustic neuroma

Manjila¹,

Weidenbecher

Semaan

et al. 2013

JNS

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PostoPerative CSF leak after translabyrinthine surgery for removal of an acoustic neuroma (TLAN) is recognized as an infrequent complication, despite the best prophylactic techniques currently available. [29][30][31][32][33]36,40,44 To prevent postoperative CSF leaks after TLAN, several surgical methods have been tried, using different autografts and allografts, alone or in combinations, with varying success rates. 6,8,10,11,13,[22][23][24]27,28,42,46 These range from calvarial bone autografts, bone cements, metals, and resins to resorbable bone plates. 5,6,51 Calvarial grafts can be time consuming and less malleaPrevention of postoperative cerebrospinal fluid leaks with multilayered reconstruction using titanium mesh-hydroxyapatite cement cranioplasty after translabyrinthine resection of acoustic neuroma Object. Several prophylactic surgical methods have been tried to prevent CSF leakage after translabyrinthine resection of acoustic neuroma (TLAN). The authors report an improvised technique for multilayer watertight closure using titanium mesh-hydroxyapatite cement (HAC) cranioplasty in addition to dural substitute and abdominal fat graft after TLAN.Methods. The study was limited to 42 patients who underwent TLAN at University Hospitals Case Medical Center using this new technique from 2006 to 2012. Systematic closure of the surgical wound in layers using temporalis fascia, dural substitute, dural sealant, adipose graft, titanium mesh, and then HAC was performed in each case. Temporalis muscle and eustachian tube obliteration were not used. The main variables studied were patient age, tumor size, tumor location, cosmetic outcome, length of hospitalization, and the incidence of CSF leak, pseudomeningocele, and infection.Results. Excellent cosmetic outcome was achieved in all patients. There were no cases of postoperative CSF rhinorrhea, incisional CSF leak, or meningitis. Cosmetic results were comparable to those achieved using HAC alone. This cost-effective technique used only a third of the HAC required for traditional closure in which the entire mastoid defect is filled with cement, predisposing to infection. Postoperative CT and MRI showed excellent bony contouring and dural reconstitution, respectively.Conclusions. The authors report on successful use of titanium mesh-HAC cranioplasty in preventing postoperative CSF leak after TLAN in all cases in their series. The titanium mesh provides a well-defined anatomical dissection plane that would make reoperation easier than working through scarred soft tissue. The mesh bolsters the fat graft and keeps HAC out of direct contact with mastoid air cells, thereby reducing the risk of infection. The cement cranioplasty does not preclude subsequent implantation of a bone-anchored hearing aid.

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Cerebrospinal fluid leak after translabyrinthine acoustic neuroma surgery

Cited by 28 publications

References 11 publications

Computed Tomography Evaluation of Air Cells in the Petrous Bone-Relationship With Postoperative Cerebrospinal Fluid Rhinorrhea-

Computed Tomography Evaluation of Air Cells in the Petrous Bone-Relationship With Postoperative Cerebrospinal Fluid Rhinorrhea-

Clinical predictors of facial nerve outcome after translabyrinthine resection of acoustic neuromas

Prevention of postoperative cerebrospinal fluid leaks with multilayered reconstruction using titanium mesh–hydroxyapatite cement cranioplasty after translabyrinthine resection of acoustic neuroma

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