Abstract
Purpose
The aim of this study was to evaluate the safety and surgical outcome of superior petrosal vein (SPV, Dandy’s vein) sacrifice in translabyrinthine approach (TLA) for resection of vestibule schwannoma (VS) as compared with SPV preservation, with further investigation of preoperational factors associated with the implement of SPV sacrifice.
Methods
The authors prospectively collected data from patients surgically treated for VS through TLA between June 2021 and April 2022 at the Gruppo Otologico.
Results
There were 30 and 49 patients in SPV sacrifice and preservation groups, respectively. SPV sacrifice group had significantly larger tumor size (2.46 vs. 1.40 cm), less percentage of solid tumor (26.7% vs. 83.7%), higher incidence of brainstem compression (80% vs. 26.5%), and higher percentage of facial numbness (20.0% vs. 4.1%) than SPV preservation group. Gross total resection (GTR) rates were 73.3% after SPV sacrifice and 87.8% after SPV preservation. Facial nerve preservation rates were similar. No complication related with SPV sacrifice was observed. Logistic regression analysis showed tumor size and complete solid consistency as significant risk factors associated with SPV sacrifice. ROC curve further demonstrated tumor size as a fair predictor (AUC = 0.833), with optimum cutoff value of 1.68 cm.
Conclusion
SPV sacrifice via TLA as needed is a safe and effective maneuver for removal of relatively large VS. Tumor size and consistency can be used as a guidance in preoperational decision-making, with cutoff value of 1.68 cm and cystic formation as predictive indicators.
Similar content being viewed by others
Data availability
The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.
References
Sade B, Mohr G, Dufour JJ (2006) Vascular complications of vestibular schwannoma surgery: a comparison of the suboccipital retrosigmoid and translabyrinthine approaches. J Neurosurg 105(2):200–204. https://doi.org/10.3171/jns.2006.105.2.200
Matsushima K, Matsushima T, Kuga Y, Kodama Y, Inoue K, Ohnishi H et al (2014) Classification of the superior petrosal veins and sinus based on drainage pattern. Neurosurgery 10(Suppl 2):357–367. https://doi.org/10.1227/NEU.0000000000000323. (discussion 67)
Masuoka J, Matsushima T, Hikita T, Inoue E (2009) Cerebellar swelling after sacrifice of the superior petrosal vein during microvascular decompression for trigeminal neuralgia. J Clin Neurosci 16(10):1342–1344. https://doi.org/10.1016/j.jocn.2008.12.024
Haq IB, Susilo RI, Goto T, Ohata K (2016) Dural incision in the petrosal approach with preservation of the superior petrosal vein. J Neurosurg 124(4):1074–1078. https://doi.org/10.3171/2015.3.JNS141618
Pathmanaban ON, O’Brien F, Al-Tamimi YZ, Hammerbeck-Ward CL, Rutherford SA, King AT (2017) Safety of superior petrosal vein sacrifice during microvascular decompression of the trigeminal nerve. World Neurosurg 103:84–87. https://doi.org/10.1016/j.wneu.2017.03.117
Gharabaghi A, Koerbel A, Lowenheim H, Kaminsky J, Samii M, Tatagiba M (2006) The impact of petrosal vein preservation on postoperative auditory function in surgery of petrous apex meningiomas. Neurosurgery 59(1 Suppl 1):ONS68–ONS74. https://doi.org/10.1227/01.NEU.0000219821.34450.59. (discussion ONS68-74)
McLaughlin MR, Jannetta PJ, Clyde BL, Subach BR, Comey CH, Resnick DK (1999) Microvascular decompression of cranial nerves: lessons learned after 4400 operations. J Neurosurg 90(1):1–8. https://doi.org/10.3171/jns.1999.90.1.0001
Samii M, Tatagiba M, Carvalho GA (2000) Retrosigmoid intradural suprameatal approach to Meckel’s cave and the middle fossa: surgical technique and outcome. J Neurosurg 92(2):235–241. https://doi.org/10.3171/jns.2000.92.2.0235
Inamasu J, Shiobara R, Kawase T, Kanzaki J (2002) Haemorrhagic venous infarction following the posterior petrosal approach for acoustic neurinoma surgery: a report of two cases. Eur Arch Otorhinolaryngol 259(3):162–165. https://doi.org/10.1007/s00405-001-0433-y
Koerbel A, Gharabaghi A, Safavi-Abbasi S, Samii A, Ebner FH, Samii M et al (2009) Venous complications following petrosal vein sectioning in surgery of petrous apex meningiomas. Eur J Surg Oncol 35(7):773–779. https://doi.org/10.1016/j.ejso.2008.02.015
Nguyen-Huynh AT, Jackler RK, Pfister M, Tseng J (2007) The aborted early history of the translabyrinthine approach: a victim of suppression or technical prematurity? Otol Neurotol 28(2):269–279. https://doi.org/10.1097/MAO.0b013e31802b3264
House WF (1964) Transtemporal bone microsurgical removal of acoustic neuromas. Report of cases. Arch Otolaryngol 80:617–667
Ben Ammar M, Piccirillo E, Topsakal V, Taibah A, Sanna M (2012) Surgical results and technical refinements in translabyrinthine excision of vestibular schwannomas: the Gruppo Otologico experience. Neurosurgery 70(6):1481–1491. https://doi.org/10.1227/NEU.0b013e31824c010f. (discussion 91)
Sanna M, Russo A, Taibah A, Falcioni M, Agarwal M (2004) Enlarged translabyrinthine approach for the management of large and giant acoustic neuromas: a report of 175 consecutive cases. Ann Otol Rhinol Laryngol 113(4):319–328. https://doi.org/10.1177/000348940411300412
Mamikoglu B, Wiet RJ, Esquivel CR (2002) Translabyrinthine approach for the management of large and giant vestibular schwannomas. Otol Neurotol 23(2):224–227. https://doi.org/10.1097/00129492-200203000-00020
Horowitz SW, Leonetti JP, Azar-Kia B, Anderson D (1996) Postoperative radiographic findings following acoustic neuroma removal. Skull Base Surg 6(4):199–205. https://doi.org/10.1055/s-2008-1058626
Vrabec JT, Backous DD, Djalilian HR, Gidley PW, Leonetti JP, Marzo SJ et al (2009) Facial nerve grading system 2.0. Otolaryngol Head Neck Surg 140(4):445–450. https://doi.org/10.1016/j.otohns.2008.12.031
Gurgel RK, Jackler RK, Dobie RA, Popelka GR (2012) A new standardized format for reporting hearing outcome in clinical trials. Otolaryngol Head Neck Surg 147(5):803–807. https://doi.org/10.1177/0194599812458401
Kanzaki J, Tos M, Sanna M, Moffat DA, Monsell EM, Berliner KI (2003) New and modified reporting systems from the consensus meeting on systems for reporting results in vestibular schwannoma. Otol Neurotol 24(4):642–648. https://doi.org/10.1097/00129492-200307000-00019. (discussion 8–9)
Rauch SD, Xu WZ, Nadol JB Jr (1993) High jugular bulb: implications for posterior fossa neurotologic and cranial base surgery. Ann Otol Rhinol Laryngol 102(2):100–107. https://doi.org/10.1177/000348949310200204
Dandy WE (1932) The treatment of trigeminal neuralgia by the cerebellar route. Ann Surg 96(4):787–795. https://doi.org/10.1097/00000658-193210000-00026
Bender B, Hauser TK, Korn A, Klose U, Tatagiba M, Ernemann U et al (2018) Depiction of the superior petrosal vein complex by 3D contrast-enhanced MR angiography. AJNR Am J Neuroradiol 39(12):2249–2255. https://doi.org/10.3174/ajnr.A5864
Ebner FH, Roser F, Shiozawa T, Ruetschlin S, Kirschniak A, Koerbel A et al (2009) Petrosal vein occlusion in cerebello-pontine angle tumour surgery: an anatomical study of alternative draining pathways. Eur J Surg Oncol 35(5):552–556. https://doi.org/10.1016/j.ejso.2008.06.011
Mizutani K, Toda M, Yoshida K (2016) The analysis of the petrosal vein to prevent venous complications during the anterior transpetrosal approach in the resection of petroclival meningioma. World Neurosurg 93:175–182. https://doi.org/10.1016/j.wneu.2016.06.018
Cheng L (2016) Complications after obliteration of the superior petrosal vein: are they rare or just underreported? J Clin Neurosci 31:1–3. https://doi.org/10.1016/j.jocn.2015.11.033
Xi J, Ding X, Peng Z, Liu Q, Yuan X (2013) Protection of the superior petrosal vein in microneurosurgery for acoustic neuroma. Zhong Nan Da Xue Xue Bao Yi Xue Ban 38(7):695–698. https://doi.org/10.3969/j.issn.1672-7347.2013.07.008
Singh D, Jagetia A, Sinha S (2006) Brain stem infarction: a complication of microvascular decompression for trigeminal neuralgia. Neurol India 54(3):325–326. https://doi.org/10.4103/0028-3886.27177
Kim KH, Cho YS, Seol HJ, Cho KR, Choi JW, Kong DS et al (2021) Comparison between retrosigmoid and translabyrinthine approaches for large vestibular schwannoma: focus on cerebellar injury and morbidities. Neurosurg Rev 44(1):351–361. https://doi.org/10.1007/s10143-019-01213-1
Tschabitscher M (1979) Veins of the human cerebellum. Acta Anat (Basel) 105(3):344–366
Matsushima T, Rhoton AL Jr, de Oliveira E, Peace D (1983) Microsurgical anatomy of the veins of the posterior fossa. J Neurosurg 59(1):63–105. https://doi.org/10.3171/jns.1983.59.1.0063
Olander C, Gudjonsson O, Kinnefors A, Laurell G, Edfeldt L (2018) Complications in translabyrinthine surgery of vestibular schwannoma. Acta Otolaryngol 138(7):639–645. https://doi.org/10.1080/00016489.2018.1427887
Sampath P, Rini D, Long DM (2000) Microanatomical variations in the cerebellopontine angle associated with vestibular schwannomas (acoustic neuromas): a retrospective study of 1006 consecutive cases. J Neurosurg 92(1):70–78. https://doi.org/10.3171/jns.2000.92.1.0070
Piccirillo E, Wiet MR, Flanagan S, Dispenza F, Giannuzzi A, Mancini F et al (2009) Cystic vestibular schwannoma: classification, management, and facial nerve outcomes. Otol Neurotol 30(6):826–834. https://doi.org/10.1097/MAO.0b013e3181b04e18
Samii M, Matthies C (1997) Management of 1000 vestibular schwannomas (acoustic neuromas): surgical management and results with an emphasis on complications and how to avoid them. Neurosurgery 40(1):11–21. https://doi.org/10.1097/00006123-199701000-00002. (discussion-3)
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that no funds, grants, or other support were received during the preparation of this manuscript. The authors have no relevant conflicts of interests to disclose.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Supplementary Information
Below is the link to the electronic supplementary material.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Wang, Y., Piras, G., Lauda, L. et al. Superior petrosal vein sacrifice in translabyrinthine approach for resection of vestibule schwannoma. Eur Arch Otorhinolaryngol 281, 1195–1203 (2024). https://doi.org/10.1007/s00405-023-08208-1
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00405-023-08208-1