Abstract
Background: Surgical removal of a vestibular schwannoma is a complex and challenging procedure, which may be complicated by development of postoperative hematomas, particularly after incomplete resection of the tumor.
Objective: To investigate the occurrence of postoperative intra- or peritumoral hematomas after surgery for a vestibular schwannoma.
Methods: This retrospective study evaluated 49 patients (age range 17–78 years) with a vestibular schwannoma, who were treated surgically via the lateral suboccipital approach between 2011 and 2016. The tumors ranged in size from 0 mm (in a case of an intracanalicular lesion) to 56 mm. In 30 cases (61%), total or near-total resection was accomplished, and in 19 cases (39%), subtotal or partial resection was done. On the basis of their bleeding tendency during tumor removal, the patients were divided into a “less-bleeding” (38 cases; 78%) and a “more-bleeding” (11 cases; 22%) subgroups.
Results: A maximal vestibular schwannoma diameter >30 mm, patient age >60 years, and more bleeding during tumor removal were significantly associated with incomplete (subtotal or partial) resection. In six cases (12%), serial computed tomography after surgery demonstrated a postoperative hematoma, which was caused by insufficient irrigation of the surgical field (in two cases) or resulted from peritumoral hemorrhage (in two cases), intratumoral hemorrhage (in one case), or both intra- and peritumoral hemorrhage (in one case). The latter patient required urgent reoperation. In all cases, postoperative hematomas occurred after incomplete (subtotal or partial) resection of a vestibular schwannoma, and their development was significantly associated with more bleeding during tumor removal.
Conclusion: For avoidance of postoperative hematomas, careful hemostasis is required after completion of vestibular schwannoma removal, especially in cases with incomplete resection and an excessive bleeding tendency of the tumor tissue.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Similar content being viewed by others
References
Sanna M, Taibah A, Russo A, Falcioni M, Agarwal M. Perioperative complications in acoustic neuroma (vestibular schwannoma) surgery. Otol Neurotol. 2004;25:379–86.
Starnoni D, Daniel RT, Tuleasca C, George M, Levivier M, Messerer M. Systematic review and meta-analysis of the technique of subtotal resection and stereotactic radiosurgery for large vestibular schwannomas: a “nerve-centered” approach. Neurosurg Focus. 2018;44(3):E4.
Horowitz SW, Leonetti JP, Azar-Kia B, Anderson D. Postoperative radiographic findings following acoustic neuroma removal. Skull Base Surg. 1996;6:199–205.
Iannella G, de Vincentiis M, Di Gioia C, Carletti R, Pasquariello B, Manno A, Angeletti D, Savastano E, Magliulo G. Subtotal resection of vestibular schwannoma: evaluation with Ki-67 measurement, magnetic resonance imaging, and long-term observation. J Int Med Res. 2017;45:1061–73.
Kageji T, Nagahiro S, Mizobuchi Y, Nakajima K. Postoperative hematoma requiring recraniotomy in 1149 consecutive patients with intracranial tumors. Oper Neurosurg (Hagerstown). 2017;13:392–7.
Goto T, Muraoka H, Kodama K, Hara Y, Yako T, Hongo K. Intraoperative monitoring of motor evoked potential for the facial nerve using a cranial peg-screw electrode and a “threshold-level” stimulation method. Skull Base. 2010;20:429–34.
Watanabe S, Yamamoto M, Kawabe T, Koiso T, Yamamoto T, Matsumura A, Kasuya H. Stereotactic radiosurgery for vestibular schwannomas: average 10-year follow-up results focusing on long-term hearing preservation. J Neurosurg. 2016;125(Suppl):64–72.
Iwai Y, Yamanaka K, Ishiguro T. Surgery combined with radiosurgery of large acoustic neuromas. Surg Neurol. 2003;59:283–91.
Yamakami I, Kobayashi E, Iwadate Y, Saeki N, Yamaura A. Hypervascular vestibular schwannomas. Surg Neurol. 2002;57:105–12.
Elliott-Lewis EW, Mason AM, Barrow DL. Evaluation of a new bipolar coagulation forceps in a thermal damage assessment. Neurosurgery. 2009;65:1182–7.
Jackson MR. Fibrin sealants in surgical practice: an overview. Am J Surg. 2001;182(2 Suppl):1S–7S.
Conflict of Interest Statement
The authors have no conflict of interest concerning the reported materials or methods.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2023 Springer Nature Switzerland AG
About this paper
Cite this paper
Goto, T. et al. (2023). Postoperative Intratumoral or Peritumoral Hematomas After Vestibular Schwannoma Resection. In: Turel, K.E., Chernov, M.F., Sarkar, H. (eds) Complications in Neurosurgery. Acta Neurochirurgica Supplement, vol 130. Springer, Cham. https://doi.org/10.1007/978-3-030-12887-6_7
Download citation
DOI: https://doi.org/10.1007/978-3-030-12887-6_7
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-030-12886-9
Online ISBN: 978-3-030-12887-6
eBook Packages: MedicineMedicine (R0)