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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

 

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