Emily Guazzo1,2,3, Benedict Panizza4,2,3,5, Andrew Lomas2,6,3,5, Martin Wood2,5, Damien Amato7,2,5, Andrew Alalade8, Mitesh Gandhi9,2, James Bowman4,5. 1. Department of Otolaryngology, Head and Neck Surgery, Ipswich Hospital. 2. Queensland Skull Base Unit, Princess Alexandra Hospital. 3. Faculty of Medicine, University of Queensland. 4. Department of Otolaryngology, Head and Neck Surgery. 5. Brisbane Clinical Neurosciences Centre, Mater Hospital, Brisbane, Australia. 6. Department of Otolaryngology, Head and Neck Surgery, Royal Brisbane and Women's Hospital. 7. Department of Neurosurgery. 8. Department of Neurosurgery, The Walton Centre NHS Foundation Trust Liverpool, United Kingdom. 9. Department of Radiology.
Abstract
OBJECTIVE: To prospectively evaluate the incidence, risk factors and natural history of postoperative cerebral venous sinus thrombosis (pCVST) in translabyrinthine vestibular schwannoma microsurgical resection and propose a potential management paradigm. STUDY DESIGN: Prospective, single cohort, multicenter study. SETTING: State-wide academic tertiary referral centers. PATIENTS: Fifty-four consecutive patients who underwent translabyrinthine vestibular schwannoma resection. MAIN OUTCOME MEASURES: Incidence of pCVST on postoperative imaging on Day 7, Day 28, and 12 months postoperatively. Patients and tumor characteristics, risk factors, length of stay, intraoperative parameters, complications, and follow-up were analyzed. RESULTS: pCVST was demonstrated in 21 patients (38.9%) on postoperative imaging. All patients with pCVST were treated conservatively and remained asymptomatic in the immediate postoperative period and long-term follow-up. There were no instances of venous infarction, intracranial hemorrhage, or neurological deficits. A majority (61.1%) of pCVST recannalised on long-term follow up with conservative management. There was a statistical association with pCVST and surgery on the side of the non-dominant cerebral venous drainage (n = 17, 80.1%, p = 0.034). Patients with pCVST were significantly more likely to have a postoperative cerebrospinal fluid (CSF) leak (n = 5, 23.8%, p = 0.017). CONCLUSION: The incidence of pCVST following translabyrinthine vestibular schwannoma resection is much higher than previously recognized. pCVST is more likely to occur when surgery is performed on tumors situated on the side of non-dominant cerebral venous drainage. Despite the high prevalence of this iatrogenic phenomenon, all patients were asymptomatic and a majority resolved, thereby suggesting that conservative management is safe. Correlation between pCVST and increased incidence of CSF leak requires further investigation.
OBJECTIVE: To prospectively evaluate the incidence, risk factors and natural history of postoperative cerebral venous sinus thrombosis (pCVST) in translabyrinthine vestibular schwannoma microsurgical resection and propose a potential management paradigm. STUDY DESIGN: Prospective, single cohort, multicenter study. SETTING: State-wide academic tertiary referral centers. PATIENTS: Fifty-four consecutive patients who underwent translabyrinthine vestibular schwannoma resection. MAIN OUTCOME MEASURES: Incidence of pCVST on postoperative imaging on Day 7, Day 28, and 12 months postoperatively. Patients and tumor characteristics, risk factors, length of stay, intraoperative parameters, complications, and follow-up were analyzed. RESULTS:pCVST was demonstrated in 21 patients (38.9%) on postoperative imaging. All patients with pCVST were treated conservatively and remained asymptomatic in the immediate postoperative period and long-term follow-up. There were no instances of venous infarction, intracranial hemorrhage, or neurological deficits. A majority (61.1%) of pCVST recannalised on long-term follow up with conservative management. There was a statistical association with pCVST and surgery on the side of the non-dominant cerebral venous drainage (n = 17, 80.1%, p = 0.034). Patients with pCVST were significantly more likely to have a postoperative cerebrospinal fluid (CSF) leak (n = 5, 23.8%, p = 0.017). CONCLUSION: The incidence of pCVST following translabyrinthine vestibular schwannoma resection is much higher than previously recognized. pCVST is more likely to occur when surgery is performed on tumors situated on the side of non-dominant cerebral venous drainage. Despite the high prevalence of this iatrogenic phenomenon, all patients were asymptomatic and a majority resolved, thereby suggesting that conservative management is safe. Correlation between pCVST and increased incidence of CSF leak requires further investigation.
Authors: Christina Gerges; Patrick Malloy; Nicholas Rabah; Dana Defta; Yifei Duan; Christina H Wright; Marte van Keulen; James Wright; Sarah Mowry; Cliff A Megerian; Nicholas Bambakidis Journal: J Neurol Surg B Skull Base Date: 2021-02-04
Authors: Tarek Rayan; Ahmed Helal; Christopher S Graffeo; Avital Perry; Lucas P Carlstrom; Colin L W Driscoll; Michael J Link Journal: J Neurol Surg B Skull Base Date: 2021-05-31
Authors: Kamil Krystkiewicz; Dawid Wrona; Marcin Tosik; Marcin Birski; Łukasz Szylberg; Anna Morawska; Jacek Furtak; Cezary Wałęsa; Konrad Stopa; Marek Harat Journal: Neurosurg Rev Date: 2022-01-21 Impact factor: 3.042