Perioperative Complications in Acoustic Neuroma (Vestibular Schwannoma) Surgery

Sanna, Mario; Taibah, Abdelkader; Russo, Alessandra; Falcioni, Maurizio; Agarwal, Manoj

doi:10.1097/00129492-200405000-00029

Cited by 136 publications

(115 citation statements)

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“…While many tumors are detected incidentally during work-up for unrelated issues, some present with clinical symptoms including hearing loss, tinnitus, vertigo and unsteadiness. Microsurgical resection leads to good tumor control, but facial and hearing function is compromised in a significant number of patients, particularly those with larger tumors [10].…”

Section: Introductionmentioning

confidence: 99%

Clinical outcome after Hypofractionated Stereotactic Radiotherapy (HSRT) for benign skull base tumors

Mahadevan¹,

Floyd²,

Wong

et al. 2011

Computer Aided Surgery

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Section: Introductionmentioning

confidence: 99%

Clinical outcome after Hypofractionated Stereotactic Radiotherapy (HSRT) for benign skull base tumors

Mahadevan¹,

Floyd²,

Wong

et al. 2011

Computer Aided Surgery

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“…To this end, some criteria have been consistently established in the literature, and factors for consideration have been named: tumor size, patient age and overall health status, anatomy of the vestibule and CPA, involvement of the brainstem and facial nerve, and extent of involvement of the IAC. 19,20,80,93 One group suggested the surgeon's comfort as one of the main determinants of this choice. 45 Anderson et al 2 suggested a combined translabyrinthine and retrosigmoid approach for very large tumors (diameter > 3 cm), as this allows better proximal and distal identification of the facial nerve.…”

mentioning

confidence: 99%

“…20 This route is also indicated for patients with useful preoperative hearing (although the definition of "useful" is still open to debate). 25,80,93 The retrosigmoid approach is well known to neurosurgeons and allows a panoramic visualization of the CPA. 49 Opponents of this approach quote cerebellar retraction as a risk for postoperative ataxia 42,88 and maintain that this approach carries a higher incidence of postoperative headache.…”

mentioning

confidence: 99%

Surgery for vestibular schwannomas: a systematic review of complications by approach

Ansari

Terry

Cohen-Gadol

2012

FOC

240

203

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Object Various studies report outcomes of vestibular schwannoma (VS) surgery, but few studies have compared outcomes across the various approaches. The authors conducted a systematic review of the available data on VS surgery, comparing the different approaches and their associated complications. Methods MEDLINE searches were conducted to collect studies that reported information on patients undergoing VS surgery. The authors set inclusion criteria for such studies, including the availability of follow-up data for at least 3 months, inclusion of preoperative and postoperative audiometric data, intraoperative monitoring, and reporting of results using established and standardized metrics. Data were collected on hearing loss, facial nerve dysfunction, persistent postoperative headache, CSF leak, operative mortality, residual tumor, tumor recurrence, cranial nerve (CN) dysfunction involving nerves other than CN VII or VIII, and other neurological complications. The authors reviewed data from 35 studies pertaining to 5064 patients who had undergone VS surgery. Results The analyses for hearing loss and facial nerve dysfunction were stratified into the following tumor categories: intracanalicular (IC), size (extrameatal diameter) < 1.5 cm, size 1.5–3.0 cm, and size > 3.0 cm. The middle cranial fossa approach was found to be superior to the retrosigmoid approach for hearing preservation in patients with tumors < 1.5 cm (hearing loss in 43.6% vs 64.3%, p < 0.001). All other size categories showed no significant difference between middle cranial fossa and retrosigmoid approaches with respect to hearing loss. The retrosigmoid approach was associated with significantly less facial nerve dysfunction in patients with IC tumors than the middle cranial fossa method was; however, neither differed significantly from the translabyrinthine corridor (4%, 16.7%, 0%, respectively, p < 0.001). The middle cranial fossa approach differed significantly from the translabyrinthine approach for patients with tumors < 1.5 cm, whereas neither differed from the retrosigmoid approach (3.3%, 11.5%, and 7.2%, respectively, p = 0.001). The retrosigmoid approach involved less facial nerve dysfunction than the middle cranial fossa or translabyrinthine approaches for tumors 1.5–3.0 cm (6.1%, 17.3%, and 15.8%, respectively; p < 0.001). The retrosigmoid approach was also superior to the translabyrinthine approach for tumors > 3.0 cm (30.2% vs 42.5%, respectively, p < 0.001). Postoperative headache was significantly more likely after the retrosigmoid approach than after the translabyrinthine approach, but neither differed significantly from the middle cranial fossa approach (17.3%, 0%, and 8%, respectively; p < 0.001). The incidence of CSF leak was significantly greater after the retrosigmoid approach than after either the middle cranial fossa or translabyrinthine approaches (10.3%, 5.3%, 7.1%; p = 0.001). The incidences of residual tumor, mortality, major non-CN complications, residual tumor, tumor recurrence, and dysfunction of other cranial nerves were not significantly different across the approaches. Conclusions The middle cranial fossa approach seems safest for hearing preservation in patients with smaller tumors. Based on the data, the retrosigmoid approach seems to be the most versatile corridor for facial nerve preservation for most tumor sizes, but it is associated with a higher risk of postoperative pain and CSF fistula. The translabyrinthine approach is associated with complete hearing loss but may be useful for patients with large tumors and poor preoperative hearing.

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“…En general aparece con más frecuencia tras la vía retrosigmoidea, la fosa media y con mucha menos frecuencia con la vía translaberíntica 46 . Las complicaciones graves como hidrocefalia, secuelas neurológicas severas, o exitus ocurren en menos del 2% de los casos en centros con experiencia [47][48] .…”

Section: Abordaje Retrosigmoideounclassified