Translabyrinthine Craniotomy Is Associated with Higher Risk of Asymptomatic Dural Venous Sinus Thrombosis in Vestibular Schwannoma Resection

Abstract

Objective Characterize the incidence, risk factors, and patient outcomes of dural venous sinus thrombosis identified on postoperative imaging after retrosigmoid or translabyrinthine craniotomy for vestibular schwannoma resection. Study Design Retrospective cohort study. Setting Single tertiary academic referral center. Patients Eighty-one patients 19 to 82 years of age with vestibular schwannomas, 58% female. Interventions Retrosigmoid or translabyrinthine craniotomy with postoperative magnetic resonance imaging/magnetic resonance venography. Main Outcome Measures Association between operative approach, age, sex, body mass index, tumor size, dominant sinus, operative time, laterality, and perioperative cerebrospinal fluid (CSF) leaks with rate of thrombosis. Results Translabyrinthine craniotomy was associated with the highest relative risk of thrombosis (odds ratios [OR] = 19.82, 95% confidence interval [CI] = 1.75–224, p = 0.007), followed by male sex (OR = 5.53, 95% CI = 1.63–18.8, p = 0.035). Other patient and demographic risk factors were not associated with increased rates of dural venous thrombosis, nor was there an association with postoperative CSF leak. 81% (25/31) of thrombi had resolved within 3 years of surgery. Conclusions Translabyrinthine approach and male sex most strongly predicted postoperative dural venous thrombosis after postauricular craniotomy for vestibular schwannoma resection. Professional Practice Gap and Educational Need Better understanding of risk factors and management of dural venous thrombosis after vestibular schwannoma surgery. Learning Objective Characterize clinically significant risk factors for dural venous thrombosis in vestibular schwannoma surgery. Desired Result Identification of patient and operative risk factors for dural venous thrombosis. Level of Evidence III. Indicate IRB or IACUC Exempt.