Abstract
This paper assesses the radiographic findings seen on early postoperative CT following acoustic neuroma resection. CT head scans were routinely obtained from 86 patients within 24 hours of tumor resection via a translabyrinthine or retrosigmoid approach. Repeat CT scans were performed in those patients with abnormal clinical symptoms. The abnormalities seen on postoperative CT included cerebellar hematoma (nine patients), cerebral and/or cerebellar infarction (six patients), CSF leak at the incision (two patients), subdural hematoma (two patients), hydrocephalus (one patient), and residual acoustic neuroma (two patients). An unexpected CT finding was ipsilateral temporal lobe lucency, suggesting venous edema, ischemia, and/or infarction in 16% (14/86) of patients. Overall, the clinical complication rate was 8%, and subclinical CT abnormalities were seen in 17% of patients. Temporal lobe venous edema, ischemia, or infarction is a complication of translabyrinthine resection of acoustic neuroma and is thought to be due to obstruction of an inferior temporal lobe draining vein. Some cases may be related to intraoperative interruption of the superior petrosal sinus or petrosal vein, and/or coagulation of the sigmoid sinus dural margins, interruption of an inferior temporal vein, or venous hypotension. Care in dealing with the superior petrosal and sigmoid sinuses at surgery is needed.
Full text
PDF
Images in this article
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Bryce G. E., Nedzelski J. M., Rowed D. W., Rappaport J. M. Cerebrospinal fluid leaks and meningitis in acoustic neuroma surgery. Otolaryngol Head Neck Surg. 1991 Jan;104(1):81–87. doi: 10.1177/019459989110400115. [DOI] [PubMed] [Google Scholar]
- Glasscock M. E., 3rd, Dickins J. R. Complications of acoustic tumor surgery. Otolaryngol Clin North Am. 1982 Nov;15(4):883–895. [PubMed] [Google Scholar]
- Glasscock M. E., 3rd, Hays J. W. The translabyrinthine removal of acoustic and other cerebellopontine angle tumors. Ann Otol Rhinol Laryngol. 1973 Jul-Aug;82(4):415–427. doi: 10.1177/000348947308200402. [DOI] [PubMed] [Google Scholar]
- House W. F., Hitselberger W. E. The neuro-otologist's view of the surgical management of acoustic neuromas. Clin Neurosurg. 1985;32:214–222. [PubMed] [Google Scholar]
- Leonetti J. P., Reichman O. H., Silberman S. J., Gruener G. Venous infarction following translabyrinthine access to the cerebellopontine angle. Am J Otol. 1994 Nov;15(6):723–727. [PubMed] [Google Scholar]
- Leonetti J. P., Reichman O. H., Smith P. G. Additional exposure during translabyrinthine surgery. Laryngoscope. 1992 Feb;102(2):213–216. doi: 10.1288/00005537-199202000-00018. [DOI] [PubMed] [Google Scholar]
- PERESE D. M. Superficial veins of the brain from a surgical point of view. J Neurosurg. 1960 May;17:402–412. doi: 10.3171/jns.1960.17.3.0402. [DOI] [PubMed] [Google Scholar]
- Wiet R. J., Teixido M., Liang J. G. Complications in acoustic neuroma surgery. Otolaryngol Clin North Am. 1992 Apr;25(2):389–412. [PubMed] [Google Scholar]
- Yuh W. T., Simonson T. M., Wang A. M., Koci T. M., Tali E. T., Fisher D. J., Simon J. H., Jinkins J. R., Tsai F. Venous sinus occlusive disease: MR findings. AJNR Am J Neuroradiol. 1994 Feb;15(2):309–316. [PMC free article] [PubMed] [Google Scholar]