Management of Complications in Cerebellopontine Angle Surgery in the Sitting Position

Introduction: Surgery of the cerebellopontine angle (CPA) in the sitting position carries risks that are related both to the position and to the tumor removal. We present our experience, analyze the complications rate, and present our treatment algorithm for these complications.

Methods: This study includes 115 patients who were operated on in the sitting position for CPA tumors. The patients’ files and imaging studies were evaluated. We emphasized tumor volume, length of surgery, and postoperative posterior fossa mass effect and hydrocephalus.

Results: The mean age was 48 years (range, 12 to 81 years). The most frequent pathologies were acoustic schwannoma (53%) and meningioma (38%). The mean tumor equivalent diameter (TED) was 2.97 cm. Seven patients (6%) had hematoma in the operative cavity. Postoperative hydrocephalus was identified in eight patients (7%). Ten patients (8.7%) required surgical intervention for postoperative tight posterior fossa or hydrocephalus. Out of these, one was re-operated on for posterior fossa decompression, three had placement of external ventricular drainage (EVD) catheter, and five were re-operated on for both EVD and decompression. Other then age, there was no correlation between these complications and the pathology, tumor size, or the length of surgery. There was one mortality case (0.86%) 1 month after the surgery due to sepsis.

Conclusion: High pressure of the posterior fossa after surgery for CPA tumor may be difficult to diagnose. Older patients have a higher risk for postoperative mass effect. We find that decompression should be done in cases of mass effect with clinical deterioration and that EVD alone is frequently not sufficient.