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Comparison between retrosigmoid and translabyrinthine approaches for large vestibular schwannoma: focus on cerebellar injury and morbidities

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Abstract

This study aimed to compare the surgical outcomes and morbidities of retrosigmoid and translabyrinthine approaches for large vestibular schwannoma (VS), with a focus on cerebellar injury and morbidities. Eighty-six consecutive patients with large VS, with a maximal extrameatal diameter > 3.0 cm, were reviewed between August 2010 and September 2018. The surgical outcomes, operating time, volume change of perioperative cerebellar edema, and inpatient rehabilitation related to cerebellar morbidities were compared between the two approaches. In total, 53 and 33 patients underwent the retrosigmoid and translabyrinthine approaches, respectively. The median follow-up time was 34.5 months. Surgical outcomes, including the extent of resection, tumor recurrence, and facial nerve preservation, showed no significant differences between the two groups. Patients who underwent the retrosigmoid approach showed a marginal trend for postoperative lower cranial nerve (LCN) dysfunction (P = 0.068). Although the approaching procedure time was longer in the translabyrinthine group, the tumor resection time was significantly longer in the retrosigmoid group (P = 0.001). The median change in the volume of the perioperative cerebellar edema was significantly larger in the retrosigmoid group (P < 0.001) and significantly related to the retrosigmoid approach, solid VS, and tumor resection time. Most cerebellar and LCN deficits were transient; however, the patients in the retrosigmoid group underwent inpatient rehabilitation more than those in the translabyrinthine group (P = 0.018). Both surgical approaches show equivalent surgical outcomes. Notably, the translabyrinthine approach for large VS has advantages in that it reduces cerebellar injury and related morbidities.

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Author notes

  1. Kyung Hwan Kim and Yang-Sun Cho contributed equally to this work.

Authors and Affiliations

  1. Department of Neurosurgery, Chungnam National University School of Medicine, Chungnam National University Hospital, Daejeon, South Korea

    Kyung Hwan Kim

  2. Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea

    Yang-Sun Cho

  3. Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea

    Ho Jun Seol, Kyung-Rae Cho, Jung-Won Choi, Doo-Sik Kong, Hyung Jin Shin, Do-Hyun Nam & Jung-Il Lee

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  1. Kyung Hwan Kim
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Correspondence to Ho Jun Seol.

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Ethical approval

This retrospective study was approved by the institutional review board (Samsung Medical Center; IRB No. 2018-07-009) and conducted in accordance with the ethical guidelines of the Declaration of Helsinki.

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The authors certify that all applicable institutional and governmental regulations concerning the ethical use of clinical data were adhered to for the present study; the informed consent requirement was waived.

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Kim, K.H., Cho, YS., Seol, H.J. et al. Comparison between retrosigmoid and translabyrinthine approaches for large vestibular schwannoma: focus on cerebellar injury and morbidities. Neurosurg Rev 44, 351–361 (2021). https://doi.org/10.1007/s10143-019-01213-1

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  • DOI: https://doi.org/10.1007/s10143-019-01213-1

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