Technique to prevent post-operative CSF leak in the translabyrinthine excision of vestibular schwannoma

2003 ◽  
Vol 117 (12) ◽  
pp. 965-968 ◽  
Author(s):  
M. Sanna ◽  
Rohit ◽  
L. J. Skinner ◽  
Y. Jain
Keyword(s):  
Cerebrospinal Fluid ◽  
Temporal Bone ◽  
Vestibular Schwannoma ◽  
World Literature ◽  
Internal Auditory Canal ◽  
Posterior Wall ◽  
Csf Leak ◽  
The World ◽  
Petrous Temporal Bone ◽  
Vs Removal

Cerebrospinal fluid (CSF) leak following VS removal is a challenging complication. With experience, it can be seen that anatomical factors such as the extent of pneumatization of the petrous temporal bone and posterior wall of the internal auditory canal play animportant role in contributing to CSF leak. Nevertheless, the risk of post-operative CSF leak remains a major concern for both the surgeon and patient. This paper describes a technique, which we have used since 1994, and which has helped us to achieve the lowest reported rate of post-operative CSF leak in translabyrinthine excision of vestibular schwannoma in the world literature.

scholarly journals An aberrant venous channel mimicking the perilabyrinthine cells in the petrous bone of a patient with vestibular schwannoma: illustrative case

2021 ◽  
Vol 2 (18) ◽  
Author(s):  
Masato Ito ◽  
Yoshinori Higuchi ◽  
Kentaro Horiguchi ◽  
Shigeki Nakano ◽  
Shinichi Origuchi ◽  
...  
Keyword(s):  
Vestibular Schwannoma ◽  
Internal Auditory Canal ◽  
Posterior Wall ◽  
Anatomical Variations ◽  
Petrous Bone ◽  
Bone Defects ◽  
Jugular Bulb ◽  
Illustrative Case ◽  
Computed Tomographic ◽  
Major Vein

BACKGROUND Anatomical variations, such as high jugular bulbs and air cell development in the petrosal bone, should be evaluated before surgery. Most bone defects in the internal auditory canal (IAC) posterior wall are observed in the perilabyrinthine cells. An aberrant vascular structure passing through the petrous bone is rare. OBSERVATIONS A 48-year-old man presented with a right ear hearing disturbance. Magnetic resonance imaging revealed a 23-mm contrast-enhancing mass in the right cerebellopontine angle extending into the IAC, consistent with a right vestibular schwannoma. Preoperative bone window computed tomographic scans showed bone defects in the IAC posterior wall, which ran farther posteroinferiorly in the petrous bone, reaching the medial part of the jugular bulb. The tumor was accessed via a lateral suboccipital approach. There was no other major vein in the cerebellomedullary cistern, except for the vein running from the brain stem to the IAC posterior wall. To avoid complications due to venous congestion, the authors did not drill out the IAC posterior wall or remove the tumor in the IAC. LESSONS Several aberrant veins in the petrous bone are primitive head sinus remnants. Although rare, their surgical implication is critical in patients with vestibular schwannomas.

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 Purely endoscopic pterional extradural approach: A novel technique for repair of cerebrospinal fluid rhinorrhea

2016 ◽  
Vol 07 (02) ◽  
pp. 310-313 ◽  
Author(s):  
Ajit Kumar Sinha ◽  
Sumit Goyal
Keyword(s):  
Cerebrospinal Fluid ◽  
Neurological Deficit ◽  
Frontal Sinus ◽  
Intraoperative Complications ◽  
Posterior Wall ◽  
Csf Leak ◽  
Csf Rhinorrhea ◽  
Cerebrospinal Fluid Rhinorrhea ◽  
Novel Technique ◽  
Extradural Approach

ABSTRACT Study Design: Retrospective descriptive study of an innovative surgical technique. Objective: To assess the feasibility and success of repair of transfrontal sinus cerebrospinal fluid (CSF) rhinorrhea through pterional transcranial extradural approach using endoscope. Summary of Background Data: Repair of CSF rhinorrhea has seen advancement with the evolution of endoscopic transnasal techniques. However, leaks from defect in the posterior wall of frontal sinus still remain a challenge for the skull base surgeons and requires conventional craniotomy more often. We describe a novel technique to repair these leaks by purely endoscopic pterional extradural (PEPE) approach thereby avoiding complications associated with conventional craniotomy and endoscopic transnasal approaches. Materials and Methods: Thirty-five patients with traumatic CSF rhinorrhea from the posterior wall of frontal sinus underwent repair with the present technique. They were followed up for 6–18 months and were evaluated for feasibility of procedure, recurrence of leak, and occurrence of the fresh neurological deficit. Results: Thirty-five patients underwent CSF rhinorrhea repair using the above technique. The procedure was accomplished in all patients without any intraoperative complications. There was no requirement of blood transfusion in any case. All patients had a cessation of CSF leak in the postoperative period, and there was no recurrence. There was no evidence of frontal lobe retraction injury in any of these patients, and no fresh neurological deficit was observed. Conclusion: This PEPE approach to repair CSF leak through the posterior wall of the frontal sinus is a novel technique in which we can avoid disadvantages associated with both conventional craniotomy as well as transnasal endoscopic approaches.

Cerebrospinal Rhinorrhea in a Patient with a Posterior Cranial Fossa Tumor

Neurosurgery ◽  
1987 ◽  
Vol 21 (5) ◽  
pp. 742-744 ◽  
Author(s):  
Dino Benvenuti ◽  
Angelo Lavano ◽  
Giuseppe Corriero ◽  
Claudio Irace ◽  
Enrico de Divitiis
Keyword(s):  
Cerebrospinal Fluid ◽  
Temporal Bone ◽  
Posterior Margin ◽  
Rare Case ◽  
Fistulous Tract ◽  
Posterior Cranial Fossa ◽  
Review Of The Literature ◽  
Cerebrospinal Fluid Rhinorrhea ◽  
Cranial Fossa ◽  
Petrous Temporal Bone

Abstract A rare case of a meningioma of the posterior margin of the petrous temporal bone associated with cerebrospinal fluid rhinorrhea is presented. After a careful review of the literature, the possible pathogenesis of the fistulous tract is discussed. (Neurosurgery 21:742-744, 1987)

Idiopathic diffuse erosion of the skull base presenting as cerebrospinal fluid rhinorrhoea

1998 ◽  
Vol 112 (7) ◽  
pp. 679-681 ◽  
Author(s):  
P. J. Conboy ◽  
I. J. M. Johnson ◽  
T. Jaspan ◽  
N. S. Jones
Keyword(s):  
Cerebrospinal Fluid ◽  
Skull Base ◽  
World Literature ◽  
Unusual Case ◽  
Similar Case ◽  
Bony Defect ◽  
Endoscopic Repair ◽  
The World ◽  
Csf Rhinorrhoea ◽  
The Right

AbstractWe present an unusual case of generalized erosion of the skull base. We have not found a similar case reported in the world literature. The presenting symptom was spontaneous cerebrospinal fluid (CSF) rhinorrhoea which arose from a bony defect associated with herniation of the right temporal lobe into the sphenoid sinus. We discuss the management of such a case including imaging of the skull base and the endoscopic repair of the bony defect.

scholarly journals Cerebrospinal Fluid Leak Rate after Vestibular Schwannoma Surgery via Middle Cranial Fossa Approach

2018 ◽  
Vol 80 (04) ◽  
pp. 437-440 ◽  
Author(s):  
Noga Lipschitz ◽  
Gavriel D. Kohlberg ◽  
Kareem O. Tawfik ◽  
Zoe A. Walters ◽  
Joseph T. Breen ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Vestibular Schwannoma ◽  
Middle Cranial Fossa ◽  
Leak Rate ◽  
Gross Total Resection ◽  
Csf Leak ◽  
Tumor Diameter ◽  
Total Resection ◽  
Csf Leakage ◽  
Cranial Fossa

Objective Evaluate the cerebrospinal fluid (CSF) leak rate after the middle cranial fossa (MCF) approach to vestibular schwannoma (VS) resection. Design Retrospective case series. Setting Quaternary referral academic center. Participants Of 161 patients undergoing the MCF approach for a variety of skull base pathologies, 66 patients underwent this approach for VS resection between 2007 and 2017. Main Outcome Measure Postoperative CSF leak rate. Results There were two instances of postoperative CSF leak (3.0%). Age, gender, and BMI were not significantly associated with CSF leak. In the two cases with CSF leakage, tumors were isolated to the internal auditory canal (IAC) and both underwent gross total resection. Both CSF leaks were successfully treated with lumbar drain diversion. For the 64 cases that did not have a CSF leak, 51 were isolated to the IAC, 1 was located only in the cerebellopontine angle (CPA), and 12 were located in both the IAC and CPA. 62 patients underwent gross total resection and 2 underwent near-total resection. Mean maximal tumor diameter in the CSF leak group was 4.5 mm (range: 3–6 mm) versus 10.2 mm (range: 3–19 mm) in patients with no CSF leak (p = 0.03). Conclusions The MCF approach for VS resection is a valuable technique that allows for hearing preservation and total tumor resection and can be performed with a low CSF leakage rate. This rate of CSF leak is less than the reported rates in the literature in regard to both translabyrinthine and retrosigmoid approaches.

Intrameatal thrombosed anterior inferior cerebellar artery aneurysm mimicking a vestibular schwannoma

2011 ◽  
Vol 114 (4) ◽  
pp. 1057-1060 ◽  
Author(s):  
Dennis Päsler ◽  
Jörg Baldauf ◽  
Uwe Runge ◽  
Henry W. S. Schroeder
Keyword(s):  
Vestibular Schwannoma ◽  
Internal Auditory Canal ◽  
Artery Aneurysm ◽  
Posterior Wall ◽  
Anterior Inferior Cerebellar Artery ◽  
Indocyanine Green Videoangiography ◽  
Cerebellar Artery ◽  
Aneurysm Resection ◽  
End To End ◽  
Acute Hearing Loss

Aneurysms of the anterior inferior cerebellar artery (AICA) are a rare entity. Purely intrameatal aneurysms are even rarer. The authors report an intrameatal thrombosed AICA aneurysm mimicking a vestibular schwannoma that was treated by resection and end-to-end anastomosis. This 22-year-old man presented with acute hearing loss, vertigo, and moderate facial palsy. Magnetic resonance imaging showed an atypical intrameatal lesion with dilation of the internal auditory canal. Microsurgical inspection via a retrosigmoid approach and drilling of the posterior wall of the internal auditory canal revealed a thrombosed AICA aneurysm. The aneurysm was excised, and an end-to-end suture was performed to restore AICA continuity. Intraoperative indocyanine green videoangiography as well as postoperative digital substraction angiography showed a good revascularization. Intrameatal AICA aneurysms may present with symptoms similar to vestibular schwannomas. End-to-end reanastomosis after aneurysm resection is a treatment option when clipping is impossible.

Risk Factors for Readmission with Cerebrospinal Fluid Leakage Within 30 Days of Vestibular Schwannoma Surgery

Neurosurgery ◽  
2017 ◽  
Vol 82 (5) ◽  
pp. 630-637 ◽  
Author(s):  
Ali A Alattar ◽  
Brian R Hirshman ◽  
Brandon A McCutcheon ◽  
Clark C Chen ◽  
Thomas Alexander ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cerebrospinal Fluid ◽  
Surgical Resection ◽  
Vestibular Schwannoma ◽  
Health Planning ◽  
Csf Leak ◽  
Cerebrospinal Fluid Leakage ◽  
Case Volume ◽  
Csf Leakage ◽  
First Admission

Abstract BACKGROUND Cerebrospinal fluid (CSF) leak is a well-recognized complication after surgical resection of vestibular schwannomas and is associated with a number of secondary complications, including readmission and meningitis. OBJECTIVE To identify risk factors for and timing of 30-d readmission with CSF leak. METHODS Patients who had undergone surgical resection of a vestibular schwannoma from 1995 to 2010 were identified in the California Office of Statewide Health Planning and Development database. The most common admission diagnoses were identified by International Classification of Disease, ninth Revision, diagnosis codes, and predictors of readmission with CSF leak were determined using logistic regression. RESULTS A total of 6820 patients were identified. CSF leak, though a relatively uncommon cause of admission after discharge (3.52% of all patients), was implicated in nearly half of 490 readmissions (48.98%). Significant independent predictors of readmission with CSF leak were male sex (odds ratio [OR] 1.72, 95% confidence interval [CI] 1.32-2.25), first admission at a teaching hospital (OR 3.32, 95% CI 1.06-10.39), CSF leak during first admission (OR 1.84, 95% CI 1.33-2.55), obesity during first admission (OR 2.10, 95% CI 1.20-3.66), and case volume of first admission hospital (OR of log case volume 0.82, 95% CI 0.70-0.95). Median time to readmission was 6 d from hospital discharge. CONCLUSION This study has quantified CSF leak as an important contributor to nearly half of all readmissions following vestibular schwannoma surgery. We propose that surgeons should focus on technical factors that may reduce CSF leakage and take advantage of potential screening strategies for the detection of CSF leakage prior to first admission discharge.

scholarly journals Cerebrospinal Fluid Leak During Stapes Surgery: The Importance of Temporal Bone CT Reconstructions in Oblique Anatomically Oriented Planes

2021 ◽  
pp. 014556132098456
Author(s):  
Massimo Re ◽  
Mirko Giannoni ◽  
Alfonso Scarpa ◽  
Claudia Cassandro ◽  
Massimo Ralli ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Temporal Bone ◽  
Internal Auditory Canal ◽  
Cerebrospinal Fluid Leak ◽  
High Resolution Computed Tomography ◽  
Temporal Bone Ct ◽  
Patients At Risk ◽  
Bone Structures ◽  
Fluid Leak

Stapes gusher is a massive flow of perilymph and cerebrospinal fluid leak that fills the middle ear immediately after surgical opening of the labyrinth, such as during stapedectomy. Stapes gusher usually occurs as the result of a congenital malformation that causes an abnormal communication between the perilymphatic space and the subarachnoid space involving the internal auditory canal or the cochlear duct. To date, the potential risk of stapes gusher cannot be assessed preoperatively, as there are not pathognomonic signs suggestive of this complication. However, high-resolution computed tomography scan (HRCT) of the temporal bone can provide information that may help recognizing patients at risk. Recently, an anatomic evaluation of the inner ear with oblique reformation at HRCT has been described. This reformation offers a new and more detailed topographic vision of temporal bone structures compared to the classic axial and coronal planes and may help identifying anatomical alterations otherwise not visible. In this article, we present a case of stapes gusher and the role of preoperative HRCT with oblique reformation in its prevention.

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