Surgical Outcome of Cerebellopontine Angle Tumours by Retrosigmoid Approach
Keywords:
Retrosigmoid approach, cerebellopontine angle, House – Brackmann gradingAbstract
Objective: To determine the microsurgical outcome of cerebellopontine angle tumours by the retrosigmoid approach. Study Design: Quasi experimental study. Place and Duration of Study: Departments of Neurosurgery Lahore General Hospital and mayo hospital, Lahore from January 1998 to June 2015. Materials and Methods: Four hundred and fifty six patients of cerebellopontine angle tumours of various histologies were operated at the Departments of Neurosurgery, Lahore General Hospital and mayo hospital, Lahore, from Jan 1998 to June 2015. All patients with unilateral or bilateral lesions from 15 to 65 yrs of age and with all different pathologies in cerebellopontine angle were included in the study. Complete blood count, X-Ray Chest and MRI Brain plain and with I.V contrast were done. Patients with pre-operative radiosurgery, multiple surgeries and those unfit for surgery were excluded from the study. All patients were operated under general anaesthesia by retrosigmoid approach in park bench position. Preservation of the facial nerve was attempted in all cases. Post op facial nerve status was compared with pre-op grade by House – Brackman grading. Post op development of hydrocephalus and other cranial nerve complications were also noted and overall morbidity and mortality was studied.
Results: Four hundred and fifty six patients, 274 men (60.1%) and 182 women (39.9%), underwent micro-surgical excision of cerebellopontine angle tumours. 410 (89.9%) patients were vestibular schwannomas,22 (4.8%) were meningioma, 9 (1.9%) were epidermoid and 13 (2.8%) were all other pathologies in cerebello-pontine angle tumours. Patient ages ranged from 15 to 65 years (mean 44.11±8.41 years). All patients were operated by the Retrosigmoid approach. Complete resection was achieved in 237 patients (51.9%), subtotal resection (STR) in 209 patients (45.8%), and near-total resection (NTR) in 10 patients (2.1%). Good facial nerve outcomes (House-Brackmann [HB] Grades I-III) were achieved in 82% of the patients who had undergone either NTR or STR, as compared with 73% of patients who had undergone gross-total resection (GTR). Complications included wound infection (2 patients), delayed CSF leakage 10 (2.1% of patients), hydrocephalus requiring VP shunt in 15 (3.2%), basal cranial nerve palsy in 45 patients (9.8%) and mortality in 10 (2.1%). Conclusion: Retrosigmoid approach is relatively easy and safe approach for cerebellopontine angle tumour. Tumours of all sizes can be operated completely and facial nerve can be identified and saved with this approach with less operative time and less chances of CSF leak.
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