Microsurgical Resection of Vestibular Schwannomas: Complication Avoidance

Overview

Journal J Neurooncol

Publisher Springer

Date 2016 Sep 22

PMID 27650193

Citations 9

Authors

Shervin Rahimpour

Allan H Friedman

Takanori Fukushima

Ali R Zomorodi

Affiliations

Soon will be listed here.

Abstract

Vestibular schwannoma (VS) surgery requires appropriate patient selection, meticulous microsurgical technique and optimal post-operative care. Focused radiation is an effective alternative for the treatment of smaller VSs. For VS surgery to remain a reasonable option, surgery must be performed with a limited number of complications. Complication rates for VS surgery have increased over the last decade. This is likely due to (1) decreased surgical volume and as a result decreased microsurgical experience, (2) larger tumors undergoing surgery while smaller tumors are reserved for radiation, and (3) surgery for previously radiated tumors resulting in more difficult anatomic dissection. Appropriate management of complications is paramount. Herein, we discuss complications related to VS microsurgery and methods of avoidance. Specifically, we discuss the most frequently encountered complications, intraoperative monitoring and finally, methods of addressing these complications. With meticulous microsurgical technique, careful intraoperative monitoring and vigilant perioperative care one will ensure optimal patient outcomes.

Citing Articles

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Intraoperative ultrasonography in microsurgical resection of vestibular schwannomas via retrosigmoid approach: surgical technique and proof-of-concept illustrative case series.

Carretta A, Voglis S, Roosli C, Mazzatenta D, Krayenbuhl N, Huber A Acta Neurochir (Wien). 2024; 166(1):55.

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[Electroencephalographic microstates in vestibular schwannoma patients with tinnitus].

Zhang C, Wang X, Ding Z, Zhou H, Liu P, Xue X Nan Fang Yi Ke Da Xue Xue Bao. 2023; 43(5):793-799.

PMID: 37313821 PMC: 10267232. DOI: 10.12122/j.issn.1673-4254.2023.05.15.

Study on tinnitus-related electroencephalogram microstates in patients with vestibular schwannomas.

Zhang C, Wang X, Ding Z, Zhou H, Liu P, Xue X Front Neurosci. 2023; 17:1159019.

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Cerebrovascular Complications of Vestibular Schwannoma Surgery.

Rayan T, Helal A, Graffeo C, Perry A, Carlstrom L, Driscoll C J Neurol Surg B Skull Base. 2022; 83(Suppl 2):e443-e448.

PMID: 35832937 PMC: 9272333. DOI: 10.1055/s-0041-1730895.

References

Falcioni M, Fois P, Taibah A, Sanna M . Facial nerve function after vestibular schwannoma surgery. J Neurosurg. 2011; 115(4):820-6. DOI: 10.3171/2011.5.JNS101597. View

Wiegand D, Fickel V . Acoustic neuroma--the patient's perspective: subjective assessment of symptoms, diagnosis, therapy, and outcome in 541 patients. Laryngoscope. 1989; 99(2):179-87. DOI: 10.1288/00005537-198902000-00010. View

Gal T, Shinn J, Huang B . Current epidemiology and management trends in acoustic neuroma. Otolaryngol Head Neck Surg. 2010; 142(5):677-81. DOI: 10.1016/j.otohns.2010.01.037. View

Brennan J, Rowed D, Nedzelski J, Chen J . Cerebrospinal fluid leak after acoustic neuroma surgery: influence of tumor size and surgical approach on incidence and response to treatment. J Neurosurg. 2001; 94(2):217-23. DOI: 10.3171/jns.2001.94.2.0217. View

Higgins J, Pickard J . Intractable headache after excision of an acoustic neuroma treated by stent revascularisation of the sigmoid sinus. Br J Neurosurg. 2013; 27(6):819-21. DOI: 10.3109/02688697.2013.791665. View

Gurgel R, Dogru S, Amdur R, Monfared A . Facial nerve outcomes after surgery for large vestibular schwannomas: do surgical approach and extent of resection matter?. Neurosurg Focus. 2012; 33(3):E16. DOI: 10.3171/2012.7.FOCUS12199. View

Mazzoni A, Biroli F, Foresti C, Signorelli A, Sortino C, Zanoletti E . Hearing preservation surgery in acoustic neuroma. Slow progress and new strategies. Acta Otorhinolaryngol Ital. 2011; 31(2):76-84. PMC: 3203745. View

Song F, Hou Y, Sun G, Chen X, Xu B, Huang J . In vivo visualization of the facial nerve in patients with acoustic neuroma using diffusion tensor imaging-based fiber tracking. J Neurosurg. 2016; 125(4):787-794. DOI: 10.3171/2015.7.JNS142922. View

Romstock J, Strauss C, Fahlbusch R . Continuous electromyography monitoring of motor cranial nerves during cerebellopontine angle surgery. J Neurosurg. 2000; 93(4):586-93. DOI: 10.3171/jns.2000.93.4.0586. View

10.

Inamasu J, Shiobara R, Kawase T, Kanzaki J . Haemorrhagic venous infarction following the posterior petrosal approach for acoustic neurinoma surgery: a report of two cases. Eur Arch Otorhinolaryngol. 2002; 259(3):162-5. DOI: 10.1007/s00405-001-0433-y. View

11.

MacKeith S, Kerr R, Milford C . Trends in acoustic neuroma management: a 20-year review of the oxford skull base clinic. J Neurol Surg B Skull Base. 2014; 74(4):194-200. PMC: 3715608. DOI: 10.1055/s-0033-1342919. View

12.

Selesnick S, Liu J, Jen A, Newman J . The incidence of cerebrospinal fluid leak after vestibular schwannoma surgery. Otol Neurotol. 2004; 25(3):387-93. DOI: 10.1097/00129492-200405000-00030. View

13.

Ducic I, Felder 3rd J, Endara M . Postoperative headache following acoustic neuroma resection: occipital nerve injuries are associated with a treatable occipital neuralgia. Headache. 2012; 52(7):1136-45. DOI: 10.1111/j.1526-4610.2011.02068.x. View

14.

James M, Husain A . Brainstem auditory evoked potential monitoring: when is change in wave V significant?. Neurology. 2005; 65(10):1551-5. DOI: 10.1212/01.wnl.0000184481.75412.2b. View

15.

Scheller C, Strauss C, Fahlbusch R, Romstock J . Delayed facial nerve paresis following acoustic neuroma resection and postoperative vasoactive treatment. Zentralbl Neurochir. 2004; 65(3):103-7. DOI: 10.1055/s-2004-816268. View

16.

Kwartler J, Schulder M, Baredes S, Chandrasekhar S . Endoscopic closure of the eustachian tube for repair of cerebrospinal fluid leak. Am J Otol. 1996; 17(3):470-2. View

17.

Wanibuchi M, Fukushima T, McElveen Jr J, Friedman A . Hearing preservation in surgery for large vestibular schwannomas. J Neurosurg. 2009; 111(4):845-54. DOI: 10.3171/2008.12.JNS08620. View

18.

Colletti V, Fiorino F . Middle fossa versus retrosigmoid-transmeatal approach in vestibular schwannoma surgery: a prospective study. Otol Neurotol. 2003; 24(6):927-34. DOI: 10.1097/00129492-200311000-00018. View

19.

Betchen S, Walsh J, Post K . Self-assessed quality of life after acoustic neuroma surgery. J Neurosurg. 2003; 99(5):818-23. DOI: 10.3171/jns.2003.99.5.0818. View

20.

Farace E, Marshall L . Quality of life in acoustics. J Neurosurg. 2003; 99(5):807-8. DOI: 10.3171/jns.2003.99.5.0807. View