Acoustic neuroma (vestibular schwannoma): surgical results on 240 patients operated on dorsal decubitus position

OBJECTIVE: To evaluate the result of the surgical treatment of vestibular schwannoma (VS) operated in dorsal decubitus (mastoid position). METHOD: 240 patients with a VS underwent a retrosigmoid craniotomy for tumor resection in dorsal decubitus (mastoid position). The function of 7th and 8th cranial nerves was monitored during surgery and the opened internal auditory canal (IAC) was reconstructed using a vascularized dura flap, muscle and fibrin glue. RESULTS: Complete tumor removal was achieved in 99% of the cases, with a mortality of 1.6%. The facial nerve function was preserved in 85% of cases and hearing in 40% of the patients (with preoperative hearing) with tumors of up 1.5 cm in diameter. The incidence of cerebrospinal fluid leak was 5.8% and meningitis 2.9%. Venous air embolism was registered in 3% of cases; it was not associated to mortality. CONCLUSION: Surgical removal of VS in dorsal position has several advantages; the morbidity and mortality are very low.

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Left-sided retrosigmoid craniotomy for the resection of a vestibular schwannoma

Neurosurgical FOCUS ◽

10.3171/2014.v1.focus13450 ◽

2014 ◽

Vol 36 (v1supplement) ◽

pp. 1 ◽

Cited By ~ 1

Author(s):

Peter S. Amenta ◽

Jacques J. Morcos

Keyword(s):

Vestibular Schwannoma ◽

Tumor Resection ◽

Cranial Nerves ◽

Internal Auditory Canal ◽

Patient Positioning ◽

Standard Technique ◽

Hearing Preservation ◽

Surgical Access ◽

Wide Range ◽

Primary Means

The cerebellopontine angle is the site for a wide-range of neoplastic and vascular pathologies. The retrosigmoid craniotomy remains the primary means by which to gain surgical access to this anatomically complex region. We present our standard technique for the completion of a retrosigmoid craniotomy and the resection of a left-sided vestibular schwannoma. Anatomy pertinent to the approach, including, the transverse and sigmoid sinuses, cranial nerves, and internal auditory canal (IAC) is displayed. Special emphasis is placed on patient positioning, adequate bone removal, and tumor resection. The drilling of the IAC and tumor dissection from the VII-VIII complex is also highlighted. Hearing preservation was achieved.The video can be found here: http://youtu.be/FFZju5vcBi0.

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Analysis of risk factors for venous air embolism in the semisitting position and its impact on outcome in a consecutive series of 740 patients

Journal of Neurosurgery ◽

10.3171/2021.7.jns211107 ◽

2021 ◽

pp. 1-8

Author(s):

Shadi Al-Afif ◽

Hesham Elkayekh ◽

Mazin Omer ◽

Hans E. Heissler ◽

Dirk Scheinichen ◽

...

Keyword(s):

Risk Factors ◽

Blood Pressure ◽

Vestibular Schwannoma ◽

Tumor Resection ◽

Air Embolism ◽

Consecutive Series ◽

Surgical Performance ◽

Transthoracic Doppler Echocardiography ◽

Venous Air Embolism ◽

Arterial Blood

OBJECTIVE Routine use of the semisitting position, which offers several advantages, remains a matter of debate. Venous air embolism (VAE) is a potentially serious complication associated with the semisitting position. In this study, the authors aimed to investigate the safety of the semisitting position by analyzing data over a 20-year period. METHODS The incidence of VAE and its perioperative management were analyzed retrospectively in a consecutive series of 740 patients who underwent surgery between 1996 and 2016. The occurrence of VAE was defined by detection of bubbles on transthoracic Doppler echocardiography (TTDE) or transesophageal echocardiography (TEE) studies, a decrease of end-tidal CO2 (ETCO2) by 4 mm Hg or more, and/or an unexplained drop in systolic arterial blood pressure (≥ 10 mm Hg). From 1996 until 2013 TTDE was used, and from 2013 on TEE was used. The possible risk factors for VAE and its impact on surgical performance were analyzed. RESULTS There were 404 women and 336 men with a mean age at surgery of 49 years (range 1–87 years). Surgery was performed for infratentorial lesions in 709 patients (95.8%), supratentorial lesions in 17 (2.3%), and cervical lesions in 14 (1.9%). The most frequent pathology was vestibular schwannoma. TEE had a higher sensitivity than TTDE. While TEE detected VAE in 40.5% of patients, TTDE had a detection rate of 11.8%. Overall, VAE was detected in 119 patients (16.1%) intraoperatively. In all of these patients, VAE was apparent on TTDE or TEE. Of those, 23 patients also had a decrease of ETCO2, 18 had a drop in blood pressure, and 23 had combined decreases in ETCO2 and blood pressure. VAE was detected in 24% of patients during craniotomy before opening the dura mater, in 67% during tumor resection, and in 9% during wound closure. No risk factors were identified for the occurrence of VAE. Two patients had serious complications due to VAE. Surgical performance in vestibular schwannoma surgery was not affected by the presence of VAE. CONCLUSIONS This study shows that the semisitting position is overall safe and that VAE can be managed effectively. Persistent morbidity is very rare. The authors suggest that the semisitting position should continue to have a place in the standard armamentarium of neurological surgery.

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Endoscopic Transsphenoidal Approach for Resection of Malignant Pituitary Blastoma in an 18-Month-Old Infant: A Technical Note

Operative Neurosurgery ◽

10.1227/neu.0000000000000474 ◽

2014 ◽

Vol 10 (4) ◽

pp. 649-653 ◽

Cited By ~ 3

Author(s):

Malik Zaben ◽

Mohsin Zafar ◽

Shafqat Bukhari ◽

Paul Leach ◽

Charoline Hayhurst

Keyword(s):

Malignant Tumor ◽

Intraoperative Complications ◽

Tumor Resection ◽

Cerebrospinal Fluid Leak ◽

Technical Note ◽

Transsphenoidal Approach ◽

Nasoseptal Flap ◽

Endoscopic Endonasal ◽

One Year ◽

Fluid Leak

Abstract BACKGROUND: Sella and suprasellar tumors are increasingly managed via an endoscopic transsphenoidal approach, but infant endoscopic surgery has not been reported. Pituitary blastoma is a rare sellar malignant tumor that primarily occurs in infants and is managed by surgical resection (cytoreduction) followed by adjuvant therapy. OBJECTIVE: To describe the technique and feasibility of resection of a pituitary blastoma via endoscopic endonasal transsphenoidal approach in an 18-month-old infant. METHODS: Endoscopic endonasal transsphenoidal approach for resection of a pituitary malignant tumor in an infant. RESULTS: Near-total tumor resection was achieved. The skull base was reconstructed by using a nasoseptal flap with no cerebrospinal fluid leak or any other intraoperative complications. The postoperative course was uneventful. One-year follow-up showed complete resolution of the tumor. CONCLUSION: The endoscopic endonasal transsphenoidal approach with nasoseptal flap reconstruction could be used as a safe, yet minimally invasive and innovative technique for the resection of pituitary blastoma in infants.

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Venous Air Embolism in Sitting and Supine Patients Undergoing Vestibular Schwannoma Resection

Neurosurgery ◽

10.1097/00006123-199806000-00047 ◽

1998 ◽

Vol 42 (6) ◽

pp. 1282-1286 ◽

Cited By ~ 57

Author(s):

Derek A. Duke ◽

James J. Lynch ◽

Stephen G. Harner ◽

Ronald J. Faust ◽

Michael J. Ebersold

Keyword(s):

Vestibular Schwannoma ◽

Air Embolism ◽

Venous Air Embolism

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Efficacy of intraoperative lumbar subarachnoid drainage for prevention of cerebrospinal fluid leak after spinal cord tumor resection

Journal of Orthopaedic Science ◽

10.1016/j.jos.2017.10.007 ◽

2018 ◽

Vol 23 (2) ◽

pp. 266-272 ◽

Cited By ~ 2

Author(s):

Kazuyoshi Kobayashi ◽

Kei Ando ◽

Kenyu Ito ◽

Mikito Tsushima ◽

Akiyuki Matsumoto ◽

...

Keyword(s):

Spinal Cord ◽

Cerebrospinal Fluid ◽

Spinal Cord Tumor ◽

Tumor Resection ◽

Cerebrospinal Fluid Leak ◽

Fluid Leak

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Prevention and Management of Cerebrospinal Fluid Leak Following Vestibular Schwannoma Surgery

The Laryngoscope ◽

10.1097/00005537-200403000-00022 ◽

2004 ◽

Vol 114 (3) ◽

pp. 501-505 ◽

Cited By ~ 72

Author(s):

Andrew J. Fishman ◽

Michelle S. Marrinan ◽

John G. Golfinos ◽

Noel L. Cohen ◽

J. Thomas Roland

Keyword(s):

Cerebrospinal Fluid ◽

Vestibular Schwannoma ◽

Cerebrospinal Fluid Leak ◽

Fluid Leak

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The Incidence of Cerebrospinal Fluid Leak after Vestibular Schwannoma Surgery

Otology & Neurotology ◽

10.1097/00129492-200405000-00030 ◽

2004 ◽

Vol 25 (3) ◽

pp. 387-393 ◽

Cited By ~ 77

Author(s):

Samuel H. Selesnick ◽

Jeffrey C. Liu ◽

Albert Jen ◽

Jason Newman

Keyword(s):

Cerebrospinal Fluid ◽

Vestibular Schwannoma ◽

Cerebrospinal Fluid Leak ◽

Fluid Leak

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Aggressive, Multidisciplinary Staged Microsurgical Resection of a Giant Cervicomedullary Junction Chordoma

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0039-1695062 ◽

2019 ◽

Vol 80 (S 04) ◽

pp. S378-S379

Author(s):

Sima Sayyahmelli ◽

Ihsan Dogan ◽

Aaron M. Wieland ◽

Mark Pyle ◽

Mustafa K. Başkaya

Keyword(s):

Tumor Resection ◽

Cranial Nerves ◽

Surgical Removal ◽

Retropharyngeal Space ◽

Recurrence Rates ◽

Recent Onset ◽

Postoperative Mri ◽

Swallowing Difficulties ◽

Magnetic Resonance Imaging Mri ◽

Two Stages

Chordomas of the cranial base are locally destructive tumors since they are surrounded by significant complex neurovascular structures. Thus, their surgical removal is challenging, recurrence rates are high, and their therapeutic strategies remain controversial.In this video, we present a 47-year-old man with a recent onset of swallowing difficulties, hoarseness, and weight loss for several weeks. In the neurological examination, he had complete paralysis of the 9th, 10th, 11th, and 12th cranial nerves. Magnetic resonance imaging (MRI) showed a heterogeneously enhancing expansile invasive mass lesion centered within the clivus and involving the C1, the occipitocervical junction, the retropharynx, and the hypoglossal canal. The decision was made to proceed with multiple staged surgeries. In the first surgical stage, we performed a mastoidectomy with the infralabyrinthine approach to perform a test clip ligation of the sigmoid sinus and to resect the tumor component that extended into the infralabyrinthine space. In the second stage, we performed a far-lateral transcondylar approach for tumor resection and occipitocervical fusion. In the third stage, we used a transoral approach with endoscopic assistance to complete the excision of the remaining tumor in the retropharyngeal space and anterior aspect of C1 and C2 bodies that were not accessible in the first two stages.The surgeries and postoperative course were uneventful. Postoperative MRI showed a gross total resection of the tumor. Histopathology indicated a chordoma. The patient subsequently received proton radiotherapy and has continued to do well without recurrence at 14 months' follow-up.The link to the video can be found at: https://youtu.be/uP9OSlKg_rE.

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Short-term Progressive Spinal Deformity Following Laminoplasty Versus Laminectomy for Resection of Intradural Spinal Tumors

Neurosurgery ◽

10.1227/01.neu.0000367721.73220.c9 ◽

2010 ◽

Vol 66 (5) ◽

pp. 1005-1012 ◽

Cited By ~ 73

Author(s):

Matthew J. McGirt ◽

Giannina L. Garcés-Ambrossi ◽

Scott L. Parker ◽

Daniel M. Sciubba ◽

Ali Bydon ◽

...

Keyword(s):

Cerebrospinal Fluid ◽

Spinal Deformity ◽

Tumor Resection ◽

Cerebrospinal Fluid Leak ◽

Neurological Function ◽

Spinal Tumors ◽

Short Term ◽

Intradural Tumor ◽

Fluid Leak

Abstract OBJECTIVE Gross total resection of intradural spinal tumors can be achieved in the majority of cases with preservation of long-term neurological function. However, postoperative progressive spinal deformity complicates outcome in a subset of patients after surgery. We set out to determine whether the use of laminoplasty (LP) vs laminectomy (LM) has reduced the incidence of subsequent spinal deformity following intradural tumor resection at our institution. METHODS We retrospectively reviewed the records of 238 consecutive patients undergoing resection of intradural tumor at a single institution. The incidence of subsequent progressive kyphosis or scoliosis, perioperative morbidity, and neurological outcome were compared between the LP and LM cohorts. RESULTS One hundred eighty patients underwent LM and 58 underwent LP. Patients were 46 ± 19 years old with median modified McCormick score of 2. Tumors were intramedullary in 102 (43%) and extramedullary in 102 (43%). All baseline clinical, radiographic, and operative variables were similar between the LP and LM cohorts. LP was associated with a decreased mean length of hospitalization (5 vs 7 days; P = .002) and trend of decreased incisional cerebrospinal fluid leak (3% vs 9%; P = .14). Following LP vs LM, 5 (9%) vs 21 (12%) patients developed progressive deformity (P = .728) a mean of 14 months after surgery. The incidence of progressive deformity was also similar between LP vs LM in pediatric patients < 18 years of age (43% vs 36%), with preoperative scoliosis or loss of cervical/lumbar lordosis (28% vs 22%), or with intramedullary tumors (11% vs 11%). CONCLUSION LP for the resection of intradural spinal tumors was not associated with a decreased incidence of short-term progressive spinal deformity or improved neurological function. However, LP may be associated with a reduction in incisional cerebrospinal fluid leak. Longer-term follow-up is warranted to definitively assess the long-term effect of LP and the risk of deformity over time.

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