Sigmoid Sinus Patency following Vestibular Schwannoma Resection via Retrosigmoid versus Translabyrinthine Approach

Abstract

Introduction The treatment options for acoustic neuromas are observation with serial imaging, stereotactic radiation, or surgical resection. The most common surgical approaches are the translabyrinthine (TL), the retrosigmoid (RS), and the middle cranial fossa. During the TL approach the sigmoid sinus is decompressed with bipolar cautery to allow greater medial exposure. It is unknown if this causes any long-term narrowing or thrombus of the sigmoid sinus.

Methods We performed a retrospective review of patients who underwent acoustic neuroma resection to determine if patients undergoing a TL approach for acoustic neuroma resection develop radiographic evidence of sigmoid sinus stenosis or thrombosis compared with patients undergoing a RS approach.

Results A total of 128 patients were included in this study, 56 patients underwent a TL approach and 72 patients underwent a RS approach. We compared the preoperative and postoperative diameter of the ipsilateral and contralateral sigmoid sinus at proximal, midpoint, and distal locations on magnetic resonance imaging examinations. There was no significant difference between the preoperative and postoperative diameter of the ipsilateral or contralateral sigmoid sinus based on surgical approach.

Conclusion Decompression of the sigmoid sinus during the TL approach does not have a significant postoperative effect on the dural venous sinus patency.

Keywords

acoustic neuroma - vestibular schwannoma - resection approach - sigmoid sinus - dural venous sinus

Note

The research in this manuscript will be presented at the NASBS Annual Meeting in February 2019.

Publication History

Received: 15 November 2019

Accepted: 27 April 2020

Article published online:
05 August 2020

• References

• 1 Semaan MT, Wick CC, Kinder KJ, Stuyt JG, Chota RL, Megerian CA. Retrosigmoid versus translabyrinthine approach to acoustic neuroma resection: a comparative cost-effectiveness analysis. Laryngoscope 2016; 126 (05, Suppl 3): S5-S12
• 2 Cole T, Veeravagu A, Zhang M. et al. Retrosigmoid versus translabyrinthine approach for acoustic neuroma resection: an assessment of complications and payments in a longitudinal administrative database. Cureus 2015; 7 (10) e369
• 3 Gharabaghi A, Samii A, Koerbel A, Rosahl SK, Tatagiba M, Samii M. Preservation of function in vestibular schwannoma surgery. Neurosurgery 2007;60(02, Suppl 1):ONS124–ONS127, discussion ONS127–ONS128
• 4 Day JD, Chen DA, Arriaga M. Translabyrinthine approach for acoustic neuroma. Neurosurgery 2004; 54 (02) 391-395 , discussion 395–396
• 5 Keiper Jr GL, Sherman JD, Tomsick TA, Tew Jr JM. Dural sinus thrombosis and pseudotumor cerebri: unexpected complications of suboccipital craniotomy and translabyrinthine craniectomy. J Neurosurg 1999; 91 (02) 192-197
• 6 Abou-Al-Shaar H, Gozal YM, Alzhrani G, Karsy M, Shelton C, Couldwell WT. Cerebral venous sinus thrombosis after vestibular schwannoma surgery: a call for evidence-based management guidelines. Neurosurg Focus 2018; 45 (01) E4
• 7 Schwartz MS, Lekovic GP, Miller ME, Slattery WH, Wilkinson EP. Translabyrinthine microsurgical resection of small vestibular schwannomas. J Neurosurg 2018; 129 (01) 128-136
• 8 Apra C, Kotbi O, Turc G. et al. Presentation and management of lateral sinus thrombosis following posterior fossa surgery. J Neurosurg 2017; 126 (01) 8-16
• 9 Moore J, Thomas P, Cousins V, Rosenfeld JV. Diagnosis and management of dural sinus thrombosis following resection of cerebellopontine angle tumors. J Neurol Surg B Skull Base 2014; 75 (06) 402-408
• 10 Crocker M, Nesbitt A, Rich P, Bell B. Symptomatic venous sinus thrombosis following bone wax application to emissary veins. Br J Neurosurg 2008; 22 (06) 798-800
• 11 Sari S, Verim S, Hamcan S. et al. MRI diagnosis of dural sinus—cortical venous thrombosis: immediate post-contrast 3D GRE T1-weighted imaging versus unenhanced MR venography and conventional MR sequences. Clin Neurol Neurosurg 2015; 134: 44-54
• 12 Higgins JN, Pickard JD. Intractable headache after excision of an acoustic neuroma treated by stent revascularisation of the sigmoid sinus. Br J Neurosurg 2013; 27 (06) 819-821
• 13 Ansari SF, Terry C, Cohen-Gadol AA. Surgery for vestibular schwannomas: a systematic review of complications by approach. Neurosurg Focus 2012; 33 (03) E14
• 14 Sabab A, Sandhu J, Bacchi S, Jukes A, Zacest A. Postoperative headache following treatment of vestibular schwannoma: a literature review. J Clin Neurosci 2018; 52: 26-31
• 15 Mosek AC, Dodick DW, Ebersold MJ, Swanson JW. Headache after resection of acoustic neuroma. Headache 1999; 39 (02) 89-94