Headache after Removal of Vestibular Schwannoma Via the Retrosigmoid Approach: A Long-Term Follow-Up-Study

2003 ◽  
Vol 128 (3) ◽  
pp. 387-395 ◽  
Author(s):  
Bernhard Schaller ◽  
Ariane Baumann
Keyword(s):  
Fibrin Glue ◽  
Aseptic Meningitis ◽  
Vestibular Schwannoma ◽  
Internal Auditory Canal ◽  
Retrosigmoid Approach ◽  
Bone Flap ◽  
Posterior Aspect ◽  
Dural Closure ◽  
Postoperative Headache

OBJECTIVE: Our goal was to study the occurrence and source of origin of postcraniotomy headache syndrome after removal of vestibular schwannoma via the retrosigmoid approach. METHODS: A retrospective chart analysis was conducted of all patients with headache at 3 months after removal of vestibular schwannoma from January 1981 through March 1997 and with a minimum of 24 months of follow-up. Diagnosis was made according to the headache classification and was graded using the HARNER scale. Recovery outcome was compared in selected groups of patients with and without headache. A descriptive statistical analysis was used to analyze differences between groups. RESULTS: Of the patients who underwent retrosigmoid craniotomy for removal of vestibular schwannomas, 52 of 155 patients (34%) reported having severe headache of requiring medication every day and/or feeling incapacitated 3 months after surgery. Headache was more prevalent in those who had the bone flap replaced (94% versus 27%), if there was duraplastic or direct dura closure (0% versus 100%). Laboratory-proven aseptic meningitis, most likely due to the use of fibrin glue and drilling of posterior aspect of the internal auditory canal, was mainly associated with postoperative headache (81% versus 2%). In 75% of these cases, calcifications along the brainstem had been noted. CONCLUSION: The origin of postoperative headaches after retrosigmoid vestibular schwannoma resections is not yet fully understood. Different factors may play a role in preventing or reducing headache: dural adhesions to nuchal muscles or to subcutaneous tissues and dural tension in the case of direct dural closure may explain postoperative headache from dural tension. Intradural drilling and the use of fibrin glue may be the source of aseptic meningitis as the etiology of persistent postoperative headache. Prevention of postoperative headache may include the replacement of bone flap at the end of surgery, duraplastic instead of direct dural closure, and prevention of the use of fibrin glue or extensive drilling of the posterior aspect of internal auditory canal.

Nodular enhancement within the internal auditory canal following retrosigmoid vestibular schwannoma resection: a unique radiological pattern

2011 ◽  
Vol 115 (4) ◽  
pp. 835-841 ◽  
Author(s):  
Matthew L. Carlson ◽  
Kathryn M. Van Abel ◽  
William R. Schmitt ◽  
Colin L. W. Driscoll ◽  
Brian A. Neff ◽  
...  
Keyword(s):  
Mr Imaging ◽  
Vestibular Schwannoma ◽  
Internal Auditory Canal ◽  
High Rate ◽  
Preoperative Imaging ◽  
Incomplete Resection ◽  
Tumor Margin ◽  
Tertiary Referral Center ◽  
Original Tumor

Object The authors describe the unique occurrence of nodular enhancement within the fundus of the internal auditory canal (IAC) lateral to the preoperative radiological tumor margin following gross-total vestibular schwannoma (VS) resection. Methods The nature of the study was a retrospective chart review of records. The authors reviewed the cases of all patients who underwent microsurgical resection of a VS between January 2000 and January 2010 at a single tertiary referral center. Patients with incomplete resection, neurofibromatosis Type 2, and those with fewer than 2 postoperative MR images available for review were excluded. Postsurgical patients with IAC enhancement located lateral to the preoperative imaging–delineated tumor margin were identified. Lesion morphology was characterized on serial MR imaging studies. Clinical follow-up and outcomes were recorded. Results Over the past decade, 350 patients underwent microsurgical VS resection. Of these, 16 patients met study criteria and were found to have postsurgical enhancement in the distal aspect of the IAC lateral to the imaging limits of the preoperative tumor margin on the first postoperative MR imaging study (37.5% women, median age 45 years). Initial MR imaging was performed at a mean of 3.1 months following surgery, and the mean radiological follow-up duration was 39.8 months (range 16.4–101.9 months). None of the 16 patients developed recurrence during the follow-up course. Conclusions In contrast to previous publications that have reported a high rate of recurrence in cases involving nodular enhancement within the original tumor bed, postoperative enhancement in the IAC lateral to the original tumor margin appears to carry much less risk for tumor recurrence. These findings may be helpful when counseling patients on the recommended frequency of postoperative follow-up imaging.

scholarly journals Retrosigmoid Approach for Resection of Medium-Sized Vestibular Schwannoma

2019 ◽  
Vol 80 (S 03) ◽  
pp. S284-S284
Author(s):  
Michael J. Link ◽  
Colin L. W. Driscoll ◽  
Yening Feng ◽  
Maria Peris-Celda ◽  
Christopher S. Graffeo
Keyword(s):  
Vestibular Schwannoma ◽  
Internal Auditory Canal ◽  
Retrosigmoid Approach ◽  
Gross Total Resection ◽  
Instructional Video ◽  
Hearing Level ◽  
Facial Nerve Function ◽  
Total Resection ◽  
Pure Tone Average ◽  
Petrous Temporal Bone

Objectives This video was aimed to describe the relevant anatomy and key surgical steps of retrosigmoid approach for gross total resection of a medium-sized vestibular schwannoma (VS). Design The procedure is described in a surgical instructional video. Setting The surgery took place at a tertiary skull base referral center. Participant Patient is a 63-year-old woman who reported with nonserviceable hearing (Pure Tone Average 60 dB Hearing level, Word Recognition Score 45%), occasional tinnitus, and a VS in the left cerebellopontine angle (CPA), extending into internal auditory canal (IAC), measuring 1.7 cm parallel to the petrous temporal bone. Main Outcome Measures The VS was resected by retrosigmoid approach. Results The surgery results gross total resection of the VS with postoperative House–Brackmann grade 1 facial nerve function and no postoperative complications. Conclusion The retrosigmoid approach is a good strategy to remove VS involving the CPA and the IAC.The link to the video can be found at: https://youtu.be/B6K_UkrKitg.

scholarly journals Retrosigmoid Transmeatal Endoscope-Assisted Approach in Semi-Sitting Position for Resection of Vestibular Schwannoma: 2-D operative Video

2018 ◽  
Vol 79 (S 05) ◽  
pp. S385-S386
Author(s):  
Rocio Evangelista-Zamora ◽  
Stefan Lieber ◽  
Florian Ebner ◽  
Marcos Tatagiba
Keyword(s):  
Vestibular Schwannoma ◽  
Internal Auditory Canal ◽  
Sitting Position ◽  
Speech Discrimination ◽  
Endoscopic Assistance ◽  
Set Up ◽  
One Year ◽  
The Right ◽  
Neurovascular Structures

We present a case of a mid-sized vestibular schwannoma (T3b according to the Hannover classification) that was resected through a retrosigmoid transmeatal approach in semi-sitting position under endoscopic assistance. The patient is a 52-year-old male with acute loss of functional hearing on the right side. Audiometry confirmed a loss of up to 60 dB and lost speech discrimination, there were no associated symptoms such as tinnitus or vertigo. This 2D video demonstrates positioning, OR set-up, anatomical and surgical nuances of the skull base approach and the operative technique for microdissection of the tumor from the critical neurovascular structures, especially the facial and cochlear nerves. A gross total resection was achieved and the patient discharged home after four days with unaltered function of the facial nerve (HB I). At one year follow up there was no indication of residual or recurrence.In summary, the retrosigmoid transmeatal approach is an important and powerful tool in the armamentarium for the microsurgical management of all kinds of vestibular schwannomas. Provided the necessary anesthesiological precautions and intraoperative procedures the semi-sitting position is safe and effective. If needed, the approach can be complemented by the use of an endoscope for visualization of the distal internal auditory canal.The link to the video can be found at: https://youtu.be/pPKT4_5nIn0.

scholarly journals Chances of Improvement in Cases of Vestibular Schwannoma Presenting with Facial Nerve Weakness: Presentation of Two Cases and Literature Review

2018 ◽  
Vol 80 (01) ◽  
pp. 040-045
Author(s):  
Ahmed Rizk ◽  
Marcus Mehlitz ◽  
Martin Bettag
Keyword(s):  
Hearing Loss ◽  
Facial Nerve ◽  
Male Patient ◽  
Vestibular Schwannoma ◽  
Internal Auditory Canal ◽  
Retrosigmoid Approach ◽  
Neurophysiological Monitoring ◽  
Facial Weakness ◽  
First Case ◽  
The Brain

Background and Study Aim Facial nerve (FN) weakness as a presenting feature in vestibular schwannoma (VS) is extremely rare. We are presenting two different cases of VS with significant facial weakness and reviewed the literature for similar cases. Methods and Results We are presenting two cases of VS with significant facial weakness. The first case was a 63-year-old male patient presented with 3 weeks' history of severe left-sided facial weakness (House–Brackmann [HB] grade V) and hearing loss. Magnetic resonance imaging (MRI) of the brain showed a tumor in the left internal auditory canal. Gross total removal with anatomical and physiological FN preservation was performed through a retrosigmoid approach under neurophysiological monitoring. FN function improved postoperatively to HB grade II after 16 months. The other case was 83-year-old male patient presented with sudden left-sided hearing loss and severe facial weakness (HB grade V). MRI of the brain 2.5 years before showed a left-sided (Class-T3A) cystic VS. The tumor was asymptomatic; wait-and-scan strategy was advised by the treating neurologist. Recent MRI of the brain showed approximately three times enlargement of the tumor with brain stem compression, extensive cystic changes, and suspected intratumoral hemorrhage. Surgery was performed; the tumor was subtotally removed through a retrosigmoid approach with intraoperative FN monitoring. The FN was anatomically preserved; however, physiological preservation was not possible. Severe facial weakness with incomplete lid closure persisted postoperatively. Conclusion Surgical treatment could be offered to cases of suspected VS presenting with facial weakness, as these cases may still have a chance for improvement especially in laterally located tumors.

scholarly journals Cystic Meningioma in the Cerebellopontine Angle Mimicking Vestibular Schwannoma: A Case Report

2020 ◽  
pp. 1-3
Author(s):  
Yuekang Zhang ◽  
Yong Deng ◽  
Zhigang Lan ◽  
Chenghong Wang ◽  
Yuekang Zhang
Keyword(s):  
Vestibular Schwannoma ◽  
Tumor Invasion ◽  
Cerebellopontine Angle ◽  
Internal Auditory Canal ◽  
Neurological Dysfunction ◽  
Surgical Strategies ◽  
Cystic Meningioma ◽  
Uncommon Disease ◽  
Magnetic Resonance Imaging Mri

Cystic meningioma in the cerebellopontine angle (CPA) is an extremely uncommon disease. It is often misdiagnosed as other diseases. Its clinical features, surgical strategies and prognosis are not clearly understood. We reported a case of cystic meningioma in the CPA with tumor invasion into the internal auditory canal (IAC). Based on the typical preoperative symptoms, signs, hearing tests, and enhanced magnetic resonance imaging (MRI), the 36-year-old female patient was diagnosed with vestibular schwannoma and underwent surgical resection. Postoperative pathology revealed that the tumor was meningioma. It was totally removed without any new neurological dysfunction, and no recurrence was observed in the follow-up within 24 months. Cystic meningioma in the CPA is considered to have a high pathological grade and recurrence rate. Considering this situation, total intraoperative resection, including the enhanced wall of the tumor and postoperative follow-up may be critical.

scholarly journals Role of Craniectomy Versus Craniotomy via the Retrosigmoid Approach in Decreasing the Incidence of Postoperative Headache

2021 ◽  
Author(s):  
Can Sezer ◽  
Murat Gokten ◽  
Aykut Sezer ◽  
Inan Gezgin ◽  
Mehmet Onay ◽  
...  
Keyword(s):  
Cerebrospinal Fluid Leak ◽  
Retrosigmoid Approach ◽  
Sex Type ◽  
Postoperative Headache ◽  
Group 5 ◽  
Group 2 ◽  
Postoperative Meningitis ◽  
Fluid Leak

Background: Postoperative headache is a major complaint after RS surgery. PH affected the patient’s quality of life. The role of craniotomy in the prevention of such headaches. We aimed to evaluate the role of craniectomy versus craniotomy via the retrosigmoid approach in reducing the incidence of postoperative headaches. Materials and methods: Patients who underwent surgery between January 2012 and December 2018 were retrospectively assessed and were classified into the craniectomy and craniotomy groups. Clinical data, such as those on age, sex, type of surgery, surgical repair technique, development of infection, postoperative cerebrospinal fluid leak, postoperative meningitis, size of the bone flap, and wound infection, were collected. The severity of headache in all patients was clinically assessed using the Catalano grading system. Results: Overall, 95 patients underwent microsurgery via the retrosigmoid approach. Of these, 48 were men and 47 were women. In total, 34 patients underwent craniectomy, and 61 patients underwent craniotomy. On discharge, postoperative headache was observed in 47% (16/34) and 21% (13/61) of patients who underwent craniectomy and craniotomy, respectively ( P =.01). The incidence of headache decreased at follow-up. At 12 months after surgery, 15% of patients in the craniectomy group (5/34) and 2% of patients in the craniotomy group (2/61) experienced headache ( P =.01). Of the 61 patients in the craniotomy group, 2 (2%) had less severe headache at 12 months of follow-up. Conclusion: The severity of headache after surgery and upon discharge significantly decreased in patients who underwent craniotomy than in those who underwent craniectomy.

Retrolabyrinthine Meatotomy as Part of Retrosigmoid Approach to Expose the Whole Internal Auditory Canal: Rationale, Technique, and Outcome in Hearing Preservation Surgery for Vestibular Schwannoma

2017 ◽  
Vol 14 (1) ◽  
pp. 36-44 ◽  
Author(s):  
Antonio Mazzoni ◽  
Elisabetta Zanoletti ◽  
Luca Denaro ◽  
Alessandro Martini ◽  
Domenico d’ Avella
Keyword(s):  
Vestibular Schwannoma ◽  
Internal Auditory Canal ◽  
Residual Tumor ◽  
Hearing Preservation ◽  
Retrosigmoid Approach ◽  
Long Term Results ◽  
Consecutive Series ◽  
Unfavorable Condition ◽  
Hearing Preservation Surgery

Abstract BACKGROUND Vestibular schwannoma extending to the fundus of the internal auditory canal is currently considered an unfavorable condition for hearing preservation surgery via a retrosigmoid approach because the lateral end of the canal is hard to view directly during microsurgery. OBJECTIVE To present an improved retrolabyrinthine meatotomy (RLM) technique that enables the full length of the cochlear and facial nerves to be inspected up to their orifices on the fundus. Long-term results are briefly reported. METHODS A consecutive series of 100 cases with various degrees of fundus involvement underwent surgery via a retrosigmoid approach and RLM. The follow-up ranged from 4 to 14 yr. Outcomes on hearing and facial nerve function were recorded, and preoperative MRI findings of the tumor on the fundus were correlated with the surgical findings and the long-term radicality of the tumor resection. RESULTS Residual tumor on the fundus was identified in 3 cases, all belonging to the group with tumors adhering to the fundus. The functional results were in line with the best reported outcomes of this surgery. CONCLUSION RLM via a retrosigmoid approach seemed adequate for the purposes of hearing preservation surgery and enabled the full course of the facial and cochlear nerves through the internal auditory canal to be exposed to direct view. Tumors adhering to the vestibular quadrant of the fundus were more difficult to remove, and there were a few cases of local residual tumor.

scholarly journals Microsurgical and Endoscope Assisted Resection of a Right Intracanalicular Vestibular Schwannoma Two-Dimensional Operative Video

2019 ◽  
Vol 80 (S 03) ◽  
pp. S288-S289
Author(s):  
Chun-Yu Cheng ◽  
Zeeshan Qazi ◽  
Laligam N. Sekhar
Keyword(s):  
Vestibular Schwannoma ◽  
Coming Out ◽  
Internal Auditory Canal ◽  
Brain Magnetic Resonance Imaging ◽  
Hearing Preservation ◽  
Retrosigmoid Approach ◽  
Two Dimensional ◽  
Speech Discrimination ◽  
Far Lateral Approach ◽  
Hearing Test

A 36-year-old lady presented with tinnitus and hearing loss for 1 year which was progressively worsening. A hearing test revealed pure tone average (PTA) between 48 to 65 dB and speech discrimination of 56% at 95 dB. Brain magnetic resonance imaging (MRI) showed a right vestibular schwannoma 5 × 8 mm (Fig. 1) which extended far laterally to the fundus of internal auditory canal (IAC). A translabyrinthine approach was suggested by another neurosurgeon/neurotologist team, but the patient decided to undergo operation by retrosigmoid approach with attempted hearing preservation.She underwent a right retrosigmoid craniotomy, craniectomy, and mastoidectomy with far lateral approach. We performed petrous transcanalicular microsurgical approach with the assistance of neuroendoscope. Intraoperatively, the internal auditory artery was looping into the IAC between cranial nerves VII and VIII, and coming out inferiorly. The IAC was opened by the diamond drill, ultrasonic bone curette, and fine rongeurs. The tumor was grayish in color with filling the lateral aspect of the IAC. After circumferential dissection of the tumor capsule, the tumor was removed completely. It was arising from the inferior vestibular nerve which was stretched. The patient had vertigo and nausea postoperatively but it is steadily improving. Her hearing test has improved to a PTA of 22 dB and speech discrimination of 100% at 70 dB at 6 weeks. The postoperative MRI showed total resection.This two-dimensional video shows the technical nuances of microsurgical retrosigmoid approach and endoscopic assisted resection of an intracanalicular vestibular schwannoma and the value of attempting hearing preservation in all vestibular schwannomas (Fig. 2).The link to the video can be found at: https://youtu.be/KHrO_iDI2tw.

scholarly journals Retrosigmoid Approach for Resection of Large Cystic Vestibular Schwannoma

2019 ◽  
Vol 80 (S 03) ◽  
pp. S285-S285
Author(s):  
Michael J. Link ◽  
Colin L. W. Driscoll ◽  
Yening Feng ◽  
Maria Peris-Celda ◽  
Christopher S. Graffeo
Keyword(s):  
Vestibular Schwannoma ◽  
Tumor Resection ◽  
Retrosigmoid Approach ◽  
Cystic Tumor ◽  
Instructional Video ◽  
Facial Weakness ◽  
Profound Hearing Loss ◽  
Burning Pain ◽  
Adjacent Structures

Objectives This video was aimed to describe the surgical indications, relevant anatomy, and surgical steps of retrosigmoid approach for resection of a large cystic vestibular schwannoma (VS). Design The operative steps are described in a surgical instructional video. Setting The surgery took place at a tertiary skull base referral center. Participant Patient is a 62-year-old man who reported with right sided profound hearing loss with no word recognition, progressive dizziness and tinnitus, excruciating burning pain in the V2 distribution of right trigeminal nerve, wide-based gait, and a right cerebellopontine angle (CPA) cystic VS measuring 3.3 cm. Main Outcome Measures The large cystic VS was resected through retrosigmoid approach. Results The surgery resulted in removal of the large cystic VS with initial delayed facial weakness that completely resolved (House Brackmann grade 1) by 3 month follow-up. The patient had no other postoperative complications and is convalescing well from the procedure. Conclusion Cystic VS presents some unique challenges compared with their solid counterparts. The cystic tumor capsule may be very adherent to the adjacent structures, and distinguishing thin cyst walls from the arachnoid of the CPA, can be quite challenging. The retrosigmoid approach provides adequate surgical exposure for VS tumor resection.The link to the video can be found at: https://youtu.be/sFNvRWG465Q.

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