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J Neurol Surg B Skull Base 2022; 83(S 02): e89-e95
DOI: 10.1055/s-0040-1722716
Original Article

Functional Outcomes and Postoperative Cerebral Venous Sinus Thrombosis after Translabyrinthine Approach for Vestibular Schwannoma Resection: A Radiographic Demonstration of Anatomic Predictors

Christina Gerges
1   Case Western Reserve University School of Medicine, Cleveland, Ohio, United States
,
Patrick Malloy
1   Case Western Reserve University School of Medicine, Cleveland, Ohio, United States
,
Nicholas Rabah
1   Case Western Reserve University School of Medicine, Cleveland, Ohio, United States
,
Dana Defta
1   Case Western Reserve University School of Medicine, Cleveland, Ohio, United States
2   Department of Neurological Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, United States
,
Yifei Duan
1   Case Western Reserve University School of Medicine, Cleveland, Ohio, United States
2   Department of Neurological Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, United States
,
Christina H. Wright
1   Case Western Reserve University School of Medicine, Cleveland, Ohio, United States
2   Department of Neurological Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, United States
,
Marte van Keulen
2   Department of Neurological Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, United States
,
James Wright
1   Case Western Reserve University School of Medicine, Cleveland, Ohio, United States
2   Department of Neurological Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, United States
,
Sarah Mowry
1   Case Western Reserve University School of Medicine, Cleveland, Ohio, United States
3   Department of Otolaryngology, Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, United States
,
Cliff A. Megerian
1   Case Western Reserve University School of Medicine, Cleveland, Ohio, United States
3   Department of Otolaryngology, Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, United States
,
Nicholas Bambakidis
1   Case Western Reserve University School of Medicine, Cleveland, Ohio, United States
2   Department of Neurological Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, United States
› Author Affiliations Funding None.
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Abstract

Introduction While regarded as an effective surgical approach to vestibular schwannoma (VS) resection, the translabyrinthine (TL) approach is not without complications. It has been postulated that postoperative cerebral venous sinus thrombosis (pCVST) may occur as a result of injury and manipulation during surgery. Our objective was to identify radiologic, surgical, and patient-specific risk factors that may be associated with pCVST.

Methods The Institutional Review Board (IRB) approval was obtained and the medical records of adult patients with VS who underwent TL craniectomy at University Hospitals Cleveland Medical Center between 2009 and 2019 were reviewed. Demographic data, radiographic measurements, and tumor characteristics were collected. Outcomes assessed included pCVST and the modified Rankin score (mRS).

Results Sixty-one patients ultimately met inclusion criteria for the study. Ten patients demonstrated radiographic evidence of thrombus. Patients who developed pCVST demonstrated shorter internal auditory canal (IAC) to sinus distance (mean: 22.5 vs. 25.0 mm, p = 0.044) and significantly smaller petrous angles (mean: 26.3 vs. 32.7 degrees, p = 0.0045). Patients with good mRS scores (<3) appeared also to have higher mean petrous angles (32.5 vs. 26.8, p = 0.016). Koos' grading and tumor size, in our study, were not associated with thrombosis.

Conclusion More acute petrous angle and shorter IAC to sinus distance are objective anatomic variables associated with pCVST in TL surgical approaches.

Keywords

sinus thrombosis - translabyrinthine - vestibular schwannoma - acoustic neuroma - petrous angle - internal auditory canal


Publication History

Received: 01 August 2020

Accepted: 25 November 2020

Article published online:
04 February 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Gal TJ, Shinn J, Huang B. Current epidemiology and management trends in acoustic neuroma. Otolaryngol Head Neck Surg 2010; 142 (05) 677-681
    CrossrefPubMedGoogle Scholar
  • 2 Chamoun R, MacDonald J, Shelton C, Couldwell WT. Surgical approaches for resection of vestibular schwannomas: translabyrinthine, retrosigmoid, and middle fossa approaches. Neurosurg Focus 2012; 33 (03) E9
    CrossrefPubMedGoogle Scholar
  • 3 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 (Suppl. 03) S5-S12
    CrossrefPubMedGoogle Scholar
  • 4 Ansari SF, Terry C, Cohen-Gadol AA. Surgery for vestibular schwannomas: a systematic review of complications by approach. Neurosurg Focus 2012; 33 (03) E14
    CrossrefPubMedGoogle Scholar
  • 5 Gurgel RK, Dogru S, Amdur RL, Monfared A. Facial nerve outcomes after surgery for large vestibular schwannomas: do surgical approach and extent of resection matter?. Neurosurg Focus 2012; 33 (03) E16
    CrossrefPubMedGoogle Scholar
  • 6 Mamikoglu B, Esquivel CR, Wiet RJ. Comparison of facial nerve function results after translabyrinthine and retrosigmoid approach in medium-sized tumors. Arch Otolaryngol Head Neck Surg 2003; 129 (04) 429-431
    CrossrefPubMedGoogle Scholar
  • 7 Jean WC, Felbaum DR, Stemer AB, Hoa M, Kim HJ. Venous sinus compromise after pre-sigmoid, transpetrosal approach for skull base tumors: A study on the asymptomatic incidence and report of a rare dural arteriovenous fistula as symptomatic manifestation. J Clin Neurosci 2017; 39: 114-117
    CrossrefPubMedGoogle Scholar
  • 8 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
    CrossrefPubMedGoogle Scholar
  • 9 Leonetti JP, Reichman OH, Silberman SJ, Gruener G. Venous infarction following translabyrinthine access to the cerebellopontine angle. Am J Otol 1994; 15 (06) 723-727
    PubMedGoogle Scholar
  • 10 Sade B, Mohr G, Dufour JJ. Vascular complications of vestibular schwannoma surgery: a comparison of the suboccipital retrosigmoid and translabyrinthine approaches. J Neurosurg 2006; 105 (02) 200-204
    CrossrefPubMedGoogle Scholar
  • 11 Li PM, Fischbein NJ, Do HM, Blevins NH. Dural arteriovenous fistula following translabyrinthine resection of cerebellopontine angle tumors: report of two cases. Skull Base Rep 2011; 1 (01) 51-58
    Article in Thieme ConnectPubMedGoogle Scholar
  • 12 Bathla G, Policeni B, Hansen MR, Berbaum K. Calculating the tumor volumes in vestibular schwannomas: are the ABC/2 and volumetric methods comparable?. Otol Neurotol 2017; 38 (06) 889-894
    CrossrefPubMedGoogle Scholar
  • 13 El Kashlan HK, Fox WC, Orringer DA, Thompson BG. Translabyrinthine approach and hearing rehabilitation. In: Bambakidis N, Megerian CA, Spetzler RE. eds. Surgery of the Cerebellopontine Angle. Shelton, CT: People's Medical Publishing House; 2009: 145-162
    Google Scholar
  • 14 Liu JK, Jyung RW. Retractorless translabyrinthine approach for resection of a large acoustic neuroma: operative video and technical nuances. Neurosurg Focus 2014; 36 (1, suppl): 1-1
    CrossrefPubMedGoogle Scholar
  • 15 Obaid S, Nikolaidis I, Alzahrani M, Moumdjian R, Saliba I. Morbidity rate of the retrosigmoid versus translabyrinthine approach for vestibular schwannoma resection. J Audiol Otol 2018; 22 (04) 236-243
    CrossrefPubMedGoogle Scholar
  • 16 Benjamin CG, Sen RD, Golfinos JG. et al. Postoperative cerebral venous sinus thrombosis in the setting of surgery adjacent to the major dural venous sinuses. J Neurosurg 2018; 131 (04) 1-7
    CrossrefPubMedGoogle Scholar
  • 17 Medel R, Monteith SJ, Crowley RW, Dumont AS. A review of therapeutic strategies for the management of cerebral venous sinus thrombosis. Neurosurg Focus 2009; 27 (05) E6
    CrossrefPubMedGoogle Scholar
  • 18 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
    Article in Thieme ConnectPubMedGoogle Scholar
  • 19 Das K, Murali R, Lindstrom CJ, Couldwell WT. Symptomatic subdural hygroma and temporal lobe edema after translabyrinthine removal of acoustic neuroma. Skull Base 2001; 11 (02) 137-142
    Article in Thieme ConnectPubMedGoogle Scholar
  • 20 Guazzo E, Panizza B, Lomas A. et al. Cerebral venous sinus thrombosis after translabyrinthine vestibular schwannoma-a prospective study and suggested management paradigm. Otol Neurotol 2020; 41 (02) e273-e279
    CrossrefPubMedGoogle Scholar
  • 21 Kow CY, Caldwell J, Mchugh F, Sillars H, Bok A. Dural venous sinus thrombosis after cerebellopontine angle surgery: should it be treated?. J Clin Neurosci 2020; 75: 157-162
    CrossrefPubMedGoogle Scholar
  • 22 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
    CrossrefPubMedGoogle Scholar
  • 23 Gessler F, Bruder M, Duetzmann S. et al. Risk factors governing the development of cerebral vein and dural sinus thrombosis after craniotomy in patients with intracranial tumors. J Neurosurg 2018; 128 (02) 373-379
    CrossrefPubMedGoogle Scholar
  • 24 Abbas-Kayano RT, Solla DJF, Rabelo NN. et al. Vestibular schwannoma: predictive factors of long-term postoperative neurological outcome. Acta Otolaryngol 2020; 140 (03) 242-245
    CrossrefPubMedGoogle Scholar