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European Archives of Oto-Rhino-Laryngology

, Volume 268, Issue 5, pp 653–660 | Cite as

Post-operative complications after removal of sporadic vestibular schwannoma via retrosigmoid-suboccipital approach: current diagnosis and management

  • Stylianos Charalampakis
  • Dimitrios Koutsimpelas
  • Haralampos Gouveris
  • Wolf Mann
Review Article

Abstract

The retrosigmoid (suboccipital) approach is one of four surgical approaches for the treatment of vestibular schwannomas (acoustic neuromas). It is increasingly used by otologic surgeons, and in experienced hands is associated with improved results and more limited complications. Mortality rates are minimal and often zero, while postoperative sequelae, on the other hand, are not rare. In order to not only save the patient’s life, but also to assure good quality of life after the surgery, one must consider many different aspects of management of the respective complications. In this review the issues of current management of CSF leak and meningitis, facial paresis, headache, hearing loss, unsteadiness, disequilibrium, vertigo, tinnitus, cerebellar and brain stem injuries or abscess, vascular complications and venous air embolism after retrosigmoid approach for removal of vestibular schwannomas are presented.

Keywords

Complications Management Retrosigmoid Surgery Schwannoma Vestibular 

Notes

Acknowledgments

No sponsor provided any form of funding related to the contents of this manuscript.

Conflict of interest

None declared.

References

  1. 1.
    Fishman AJ, Marrinan MS, Golfinos JG, Cohen NL, Roland TR Jr (2004) Prevention and management of cerebrospinal fluid leak following vestibular schwannoma surgery. Laryngoscope 114:501–505PubMedCrossRefGoogle Scholar
  2. 2.
    Falcioni M, Romano G, Aggarwal N, Sanna M (2008) Cerebrospinal fluid leak after retrosigmoid excision of vestibular schwannomas. Otol Neurotol 29:384–386PubMedCrossRefGoogle Scholar
  3. 3.
    Becker SS, Jackler RK, Pitts LH (2003) Cerebrospinal fluid leak after acoustic neuroma surgery: a comparison of the translabyrinthine, middle fossa and retrosigmoid approaches. Otol Neurotol 24:107–112PubMedCrossRefGoogle Scholar
  4. 4.
    Yamakami I, Uchino Y, Kobayashi E, Yamaura A, Oka N (2004) Removal of large acoustic neurinomas (vestibular schwannomas) by the retrosigmoid approach with no mortality and minimal morbidity. J Neurol Neurosurg Psychiatry 75:453–458PubMedCrossRefGoogle Scholar
  5. 5.
    Cueva RA, Mastrodimos B (2005) Approach design and closure techniques to minimize cerebrospinal fluid leak after cerebellopontine angle tumor surgery. Otol Neurotol 26:1176–1181PubMedCrossRefGoogle Scholar
  6. 6.
    Date I, Asari S, Ohmoto T (1998) Tips for preventing cerebrospinal fluid rhinorrhea after acoustic neurinoma surgery: technical note. Skull Base Surg 8:181–183PubMedCrossRefGoogle Scholar
  7. 7.
    Cardoso AC, Fernandes YB, Ramina R, Borges G (2007) Vestibular Schwannoma: surgical results on 240 patients operated on dorsal decubitus position. Arq Neuropsiquiatr 65:605–609PubMedGoogle Scholar
  8. 8.
    Lee SH, Willcox TO Jr, Buchheit WA (2002) Current results of the surgical management of acoustic neuroma. Skull Base 12:189–195PubMedCrossRefGoogle Scholar
  9. 9.
    Selesnick S, Liu J, Jen A, Newmann J (2004) The incidence of cerebrospinal fluid leak after vestibular schwannoma surgery. Otol Neurotol 2004(25):387–393CrossRefGoogle Scholar
  10. 10.
    Yamakami I, Kobayashi E, Ono J, Yamaura A (2000) Prevention of cerebrospinal fluid leakage and delayed loss of preserved hearing after vestibular schwannoma removal: reconstruction of the internal auditory canal in the suboccipital transmeatal approach—technical note. Neurol Med Chir (Tokyo) 40:597–601CrossRefGoogle Scholar
  11. 11.
    Ludemann WO, Stieglitz LH, Gerganov V, Samii A, Samii M (2008) Fat implant is superior to muscle implant in vestibular schwannoma surgery for the prevention of cerebrospinal fluid fistulae. Neurosurgery 63:38–42CrossRefGoogle Scholar
  12. 12.
    O’Malley M, Haynes D (2008) Assessment and management of meningitis following cerebellopontine angle surgery. Curr Opin Otolaryngol Head Neck Surg 16:426–433Google Scholar
  13. 13.
    Arriaga M, Chen D (2001) Facial function in hearing preservation acoustic neuroma surgery. Arch Otolaryngol Head Neck Surg 127:543–546PubMedGoogle Scholar
  14. 14.
    Mamikoglou B, Esquivel C, Wiet R (2003) Comparison of facial nerve function results after translabyrinthine and retrosigmoid approach in medium-sized tumors. Arch Otolaryngol Head Neck Surg 129:429–431CrossRefGoogle Scholar
  15. 15.
    Ho S, Hudgens S, Wiet R (2003) Comparison of post-operative facial nerve outcomes between translabyrinthine and retrosigmoid approaches in matched-pair patients. Laryngoscope 113:2014–2020PubMedCrossRefGoogle Scholar
  16. 16.
    Kane NM, Kazanas S, Maw AR, Coakham HB, Torrens MJ, Morgan MH, Stranjalis G, Butler SR (1995) Functional outcome in patients after excision of extracanalicular acoustic neuromas using the suboccipital approach. Ann R Coll Surg Engl 77:210–216PubMedGoogle Scholar
  17. 17.
    Lee J, Fung K, Lownie SP, Parnes LS (2007) Assessing impairment and disability of facial paralysis in patients with vestibular schwannoma. Arch Otolaryngol Head Neck Surg 133:56–60PubMedCrossRefGoogle Scholar
  18. 18.
    Jacob A, Robinson LL Jr, Bortman JS, Yu L, Dodson EE, Welling DB (2007) Nerve of origin, tumor size, hearing preservation, and facial nerve outcomes in 359 vestibular schwannoma resections at a tertiary care academic center. Laryngoscope 117:2087–2092PubMedCrossRefGoogle Scholar
  19. 19.
    Grey PL, Moffat DA, Palmer CR, Hardy DG, Baguley DM (1996) Factors which influence the facial nerve outcome in vestibular schwannoma surgery. Clin Otolaryngol Allied Sci 21:409–413PubMedCrossRefGoogle Scholar
  20. 20.
    Tos M, Thomsen J (1982) The price of preservation of hearing in acoustic neuroma surgery. Ann Otol Rhinol Laryngol 91:240–245PubMedGoogle Scholar
  21. 21.
    Veronezi RJB, Fernandes YB, Borges G, Ramina R (2008) Long-term facial nerve clinical evaluation following vestibular schwannoma surgery. Arq Neuropsiquiatr 66:194–198PubMedGoogle Scholar
  22. 22.
    Buchman CA, Fucci MJ, Slattery WH, Brackmann DE, Berliner KI (1999) Intraoperative corticosteroids in acoustic tumor surgery. Am J Otol 20:386–389PubMedGoogle Scholar
  23. 23.
    Stripf T, Braun K, Gouveris H, Stripf EA, Mann WJ, Amedee RG (2007) The influence of different approaches to the cerebellopontine angle (CPA) on the function of the nervus intermedius. J Neurosurg 107:927–931PubMedCrossRefGoogle Scholar
  24. 24.
    Ashram YA, Jackler RK, Pitts LH, Yingling CD (2005) Intraoperative electrophysiologic identification of the nervus intermedius. Otol Neurotol 26:274–279PubMedCrossRefGoogle Scholar
  25. 25.
    Frommeld T, Maurer J, Mann W (1998) Postoperative vestibuläre Kompensation und Fazialisfunktion nach Akustikusneurinomoperation in Abhängigkeit vom Tumorusprung. HNO 46:324–331 (in German)Google Scholar
  26. 26.
    Maurer J, Frommeld T, Mann W (2002) Vestibular function after acoustic neuroma removal with preservation of one branch of the vestibular nerve. Otol Neurotol 23:749–754PubMedCrossRefGoogle Scholar
  27. 27.
    Gouveris H, Helling K, Victor A, Mann W (2007) Comparison of electronystagmography results with dynamic posturography findings in patients with vestibular schwannoma. Acta Otolaryngol (Stockholm) 127:839–842CrossRefGoogle Scholar
  28. 28.
    Gouveris H, Stripf T, Victor A, Mann W (2007) Dynamic posturography findings predict balance status in vestibular schwannoma patients. Otol Neurotol 28:372–375PubMedCrossRefGoogle Scholar
  29. 29.
    Mbongo F, Patko T, Vidal PP, Vibert N, Tran Ba Huy P, de Waele C (2005) Postural control in patients with unilateral vestibular lesions is more impaired in the roll than in the pitch plane: a static and dynamic posturography study. Audiol Neurotol 10:291–302CrossRefGoogle Scholar
  30. 30.
    Choy NL, Johnson N, Treleavan J, Jull G, Panizza B, Brown-Rothwell D (2006) Balance, mobility and gaze stability deficits remain following surgical removal of vestibular schwannoma (acoustic neuroma): an observational study. Aust J Physiother 52:211–216PubMedGoogle Scholar
  31. 31.
    Goksu N, Bayazit Y, Bayramoglu I, Isik B (2006) Surgical exposure in retrosigmoid approach: do we need cerebellar retractors? Surg Neurol 65:631–634PubMedCrossRefGoogle Scholar
  32. 32.
    Kim H, Johnston R, Wiet R, Kumar A (2004) Long-term effects of cerebellar retraction in the microsurgical resection of vestibular schwannomas. Laryngoscope 114:323–326PubMedCrossRefGoogle Scholar
  33. 33.
    Brackmann DE (1977) Electric response audiometry in a clinical practice. Laryngoscope 87(5 Pt 2 Suppl 5):1–33PubMedCrossRefGoogle Scholar
  34. 34.
    Gouveris H, Victor A, Mann W (2007) Cochlear origin of early hearing loss in vestibular schwannoma. Laryngoscope 117:680–683PubMedCrossRefGoogle Scholar
  35. 35.
    Sulman CG, Vecchiotti MA, Semaan MT, Lewin JS, Megerian CA (2004) Endolymphatic duct violation during retrosigmoid dissection of the internal auditory canal: a human temporal bone radiographic study. Laryngoscope 114:1936–1940PubMedCrossRefGoogle Scholar
  36. 36.
    Strauss C, Bischoff B, Neu M, Berg M, Fahlbusch R, Romstock J (2001) Vasoactive treatment for hearing preservation in acoustic neuroma surgery. J Neurosurg 95:771–777PubMedCrossRefGoogle Scholar
  37. 37.
    Gouveris H, Mann W (2009) Association between surgical steps and intraoperative auditory brainstem response and electrocochleography waveforms during hearing preservation vestibular schwannoma surgery. Eur Arch Otorhinolaryngol 266:225–229PubMedCrossRefGoogle Scholar
  38. 38.
    Andersen HT, Schrøder SA, Bonding P (2006) Unilateral deafness after acoustic neuroma surgery: subjective hearing handicap and the effect of the bone-anchored hearing aid. Otol Neurotol 27:809–814PubMedCrossRefGoogle Scholar
  39. 39.
    Gouveris H, Mewes T, Maurer J, Mann W (2005) Steroid and vasoactive treatment for acute deafness after attempted hearing preservation acoustic neuroma surgery. ORL J Otorhinolaryngol Relat Spec 67:30–33PubMedGoogle Scholar
  40. 40.
    Committee on Hearing and Equilibrium guidelines for the evaluation of hearing preservation in acoustic neuroma (vestibular schwannoma) (1993) American Academy of Otolaryngology-Head and Neck Surgery Foundation, Inc. Otolaryngol Head Neck Surg 113:179–80Google Scholar
  41. 41.
    Kanzaki J, Satoh A, Kunihiro T (1999) Does hearing preservation surgery for acoustic neuromas affect tinnitus? Skull Base surg 9:169–176PubMedCrossRefGoogle Scholar
  42. 42.
    Hacourt J, Thomsen J, Tos M (1997) Translabyrinthine vestibular schwannoma surgery: postoperative tinnitus and cochlear nerve integrity. Auris Nasus Larynx 24:21–26CrossRefGoogle Scholar
  43. 43.
    Levo H, Blomstedt G, Pyykko I (2000) Tinnitus and vestibular schwannoma surgery. Acta Otolaryngol Suppl 543:28–29PubMedGoogle Scholar
  44. 44.
    Levo H, Blomstedt G, Hirvonen T, Pyykko I (2001) Causes of persistent postoperative headaches after surgery for vestibular schwannoma. Clin Otolaryngol 26:401–406PubMedCrossRefGoogle Scholar
  45. 45.
    Jackson G, McGrew B, Forest J, Hampf C (2000) Comparison of post-operative headache after retrosigmoid approach: vestibular schwannoma resection. Am J Otol 21:412–416PubMedCrossRefGoogle Scholar
  46. 46.
    Schaller B, Baumann A (2003) Headache after removal of vestibular schwannoma via the retrosigmoid approach: a long-term follow-up study. Otolaryngol Head Neck Surg 128:387–395PubMedCrossRefGoogle Scholar
  47. 47.
    Feghali JG, Elowitz EH (1998) Split calvarial graft cranioplasty for the prevention of headache after retrosigmoid resection of acoustic neuromas. Laryngoscope 108:1450–1452PubMedCrossRefGoogle Scholar
  48. 48.
    Ojemann R (2001) Retrosigmoid approach to acoustic neuroma (vestibular schwannoma). Neurosurgery 48:553–558PubMedCrossRefGoogle Scholar
  49. 49.
    Brackmann DE, Green JD (1992) Translabyrinthine approach for acoustic tumor removal. Otolaryngol Clin North Am 25:311–329PubMedGoogle Scholar
  50. 50.
    Ryzenman JM, Pensak ML, Tew JM Jr (2005) Headache: a quality of life analysis in a cohort of 1,657 patients undergoing acoustic neuroma surgery. Results from the acoustic neuroma association. Laryngoscope 115:703–711PubMedCrossRefGoogle Scholar
  51. 51.
    Catalano PJ, Jacobowitz O, Post KD (1996) Prevention of headache after retrosigmoid removal of acoustic tumors. Am J Otol 17:904–908PubMedGoogle Scholar
  52. 52.
    Albin MS, Carroll RG, Maroon JC (1978) Clinical considerations concerning detection of venous air embolism. Neurosurgery 3:380–384PubMedCrossRefGoogle Scholar
  53. 53.
    Sade B, Mohr G, Dufour J (2006) Vascular complications of vestibular schwannoma surgery: a comparison of the suboccipital retrosigmoid and translabyrinthine approaches. J Neurosurg 105:200–204PubMedCrossRefGoogle Scholar
  54. 54.
    Patrick T, Giannini C, Ebersold J, Link M (2006) Iatrogenic cerebellar implantation of a vestibular schwannoma. J Neurosurg 104:452–456PubMedCrossRefGoogle Scholar
  55. 55.
    Miyazaki H, Deveze A, Magnan J (2005) Neuro-otologic surgery through minimally invasive retrosigmoid approach: endoscope assisted microvascular decompression, vestibular neurotomy, and tumor removal. Laryngoscope 115:1612–1617PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Stylianos Charalampakis
    • 1
  • Dimitrios Koutsimpelas
    • 1
  • Haralampos Gouveris
    • 1
  • Wolf Mann
    • 1
  1. 1.Department of Otolaryngology-Head and Neck SurgeryThe University of Mainz Hospitals and ClinicsMainzGermany

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