Download PDF
J Neurol Surg B Skull Base 2018; 79(03): 297-301
DOI: 10.1055/s-0037-1607976
Original Article
Georg Thieme Verlag KG Stuttgart · New York

A Cross-sectional Survey of the North American Skull Base Society on Vestibular Schwannoma, Part 2: Perioperative Practice Patterns of Vestibular Schwannoma in North America

Jamie J. Van Gompel
1   Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota, United States
2   Department of Neurologic Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota, United States
,
Matthew L. Carlson
1   Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota, United States
2   Department of Neurologic Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota, United States
,
R. Mark Wiet
3   Department of Otolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, United States
,
Nicole M. Tombers
1   Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota, United States
,
Anand K. Devaiah M
4   Department of Otolaryngology-Head and Neck Surgery, Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts, United States
,
Devyani Lal
5   Department of Otolaryngology-Head & Neck Surgery, Mayo Clinic College of Medicine, Phoenix, Arizona, United States
,
Jacques J. Morcos
6   Department of Neurological Surgery, University of Miami, Miller School of Medicine, Miami, Florida, United States
,
Michael J. Link
1   Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota, United States
2   Department of Neurologic Surgery, Mayo Clinic School of Medicine, Rochester, Minnesota, United States
› Author Affiliations
Further Information

Publication History

23 April 2017

19 September 2017

Publication Date:
03 November 2017 (online)

Also available at
   Permissions and Reprints

Abstract

Introduction Perioperative care of vestibular schwannoma (VS) patients is extremely variable across surgeons and institutions making practice patterns difficult to standardize. No data currently exist detailing this practice variability.

Methods The North American Skull Base Society membership was electronically surveyed regarding perioperative care of surgically operated VS patients.

Results There were 87 respondents to the survey. Surgical positioning, surgical approach utilized, and perioperative medical adjuncts are quite variable. However, of those performing retrosigmoid approaches, 49% perform this in the supine position, while 33% use a park-bench position with only 2% using the sitting position. In those performing translabyrinthine approaches, 86% perform this in supine position. Although the use of neuromonitoring appears to be standard of care (98%), other than the seventh nerve, there is substantial variability between respondents regarding monitoring of additional cranial nerves. Postoperative antibiotics are used by 65%, postoperative steroids 81%, and postoperative chemical deep vein thrombosis prophylaxis in 68% of survey respondents.

Conclusion Although the perioperative adjuncts to VS surgery are variable, there does appear to be a trend in common practice. Therefore, making surgeons aware of these trends may lead to standardized practice or alternatively trials of these variances to instruct which truly improve patient outcomes.

Keywords

vestibular schwannoma - skull base - cranial - microsurgical

Financial Material and Support

Internal departmental funding was utilized without commercial sponsorship or support.


Institutional Review Board Approval

Institutional Review Board exempted the study.


Supplementary Material

 

  • References

  • 1 Carlson ML, Glasgow AE, Grossardt BR, Habermann EB, Link MJ. Does where you live influence how your vestibular schwannoma is managed? Examining geographical differences in vestibular schwannoma treatment across the United States. J Neurooncol 2016; 129 (02) 269-279
    CrossrefPubMedSearch in Google Scholar
  • 2 Harner SG, Beatty CW, Ebersold MJ. Headache after acoustic neuroma excision. Am J Otol 1993; 14 (06) 552-555
    PubMedSearch in Google Scholar
  • 3 Harner SG, Beatty CW, Ebersold MJ. Impact of cranioplasty on headache after acoustic neuroma removal. Neurosurgery 1995; 36 (06) 1097-1099 , discussion 1099–1100
    CrossrefPubMedSearch in Google Scholar
  • 4 Mosek AC, Dodick DW, Ebersold MJ, Swanson JW. Headache after resection of acoustic neuroma. Headache 1999; 39 (02) 89-94
    CrossrefPubMedSearch in Google Scholar
  • 5 Harner SG, Daube JR, Ebersold MJ, Beatty CW. Improved preservation of facial nerve function with use of electrical monitoring during removal of acoustic neuromas. Mayo Clin Proc 1987; 62 (02) 92-102
    CrossrefPubMedSearch in Google Scholar
  • 6 Youssef AS, Downes AE. Intraoperative neurophysiological monitoring in vestibular schwannoma surgery: advances and clinical implications. Neurosurg Focus 2009; 27 (04) E9
    PubMedSearch in Google Scholar
  • 7 Aihara N, Murakami S, Takahashi M, Yamada K. Preoperative characteristics of auditory brainstem response in acoustic neuroma with useful hearing: importance as a preliminary investigation for intraoperative monitoring. Neurol Med Chir (Tokyo) 2014; 54 (04) 267-271
    CrossrefPubMedSearch in Google Scholar
  • 8 Battista RA, Wiet RJ, Paauwe L. Evaluation of three intraoperative auditory monitoring techniques in acoustic neuroma surgery. Am J Otol 2000; 21 (02) 244-248
    CrossrefPubMedSearch in Google Scholar
  • 9 Slattery III WH, Francis S, House KC. Perioperative morbidity of acoustic neuroma surgery. Otol Neurotol 2001; 22 (06) 895-902
    CrossrefPubMedSearch in Google Scholar
  • 10 Bratzler DW, Dellinger EP, Olsen KM. , et al; American Society of Health-System Pharmacists; Infectious Disease Society of America; Surgical Infection Society; Society for Healthcare Epidemiology of America. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Am J Health Syst Pharm 2013; 70 (03) 195-283
    CrossrefPubMedSearch in Google Scholar
  • 11 Kartush JM, Cannon SC, Bojrab DI, Graham MD, Schmaltz S, Kemink JL. Use of bacitracin for neurotologic surgery. Laryngoscope 1988; 98 (10) 1050-1054
    PubMedSearch in Google Scholar
  • 12 Alshehri N, Cote DJ, Hulou MM. , et al. Venous thromboembolism prophylaxis in brain tumor patients undergoing craniotomy: a meta-analysis. J Neurooncol 2016; 130 (03) 561-570
    CrossrefPubMedSearch in Google Scholar
  • 13 Magliulo G, D'Amico R, Celebrini A, Cuiuli G. Postoperative Ramsay-Hunt syndrome after acoustic neuroma resection. Viral reactivation. An Otorrinolaringol Ibero Am 2005; 32 (03) 253-259
    PubMedSearch in Google Scholar
  • 14 Bozorg Grayeli A, Ferrary E, Tubach F. , et al. Effect of corticosteroids on facial function after cerebellopontine angle tumor removal: a double-blind study versus placebo. Audiol Neurootol 2015; 20 (04) 213-221
    CrossrefPubMedSearch in Google Scholar
  • 15 Bennett ML, Jackson CG, Kaufmann R, Warren F. Postoperative imaging of vestibular schwannomas. Otolaryngol Head Neck Surg 2008; 138 (05) 667-671
    CrossrefPubMedSearch in Google Scholar