[Management of operative complications in acoustic neuroma surgery].
ABSTRACT To explore the common complications related to acoustic neuromas and to search methods for preventing from them.
One hundred and five patients with acoustic neuromas underwent 110 operations with the retrosigmoid approach, middle cranial fossa approach and labyrinth approach. All cases were followed up more than 1 month after surgery.
Of 110 cases, the most frequent complication was hearing disability which occurred in 95 cases (95/110, 86.4%). and the facial paralysis was in 63.6% (70/110) after one month. Other complications were cerebrospinal fluid fistulas (CSF, 12.7%, 14/110) , intracranial hematoma (5.5%, 6/110), cranial nerve palsies (4.5%, 5/110), meningitis (3.6%, 4/110), tetraparesis (3.6%, 4/110), balance disturbance (1.8%, 2/110), hemiparalysis and anepia (0.9%, 1/110). Effective stopping bleeding during operation and controlling blood pressure after operation, as well as keeping effective sedation in 24 hours after operation were the important ways to prevent from intracranial hematoma The haemorrhage often accrued in 48 hours post-operation. CSF in this series was another common complication in acoustic neuroma surgery. Ten cases with CSF subcutaneous retro-auricular had been successfully controlled by conservative treatment. Of 4 cases with rhinorrhea CSF, 3 of them were required surgical management, another one got self-cure by bed rest. The ventricular drainage pro-operation was the most important procedure for drawdown the hypsi-cranium pressure.
The key factors to avoid the complications include mastering the anatomy of different surgical approach, how much of the tumor size, surgical experience and preoperative evaluation of patients' imaging information and other clinical data.
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ABSTRACT: Waterjet dissection has been shown to protect intracerebral vessels, but no experience exists in applying this modality to the cranial nerves. To evaluate its potential, the authors examined waterjet dissection of the vestibulocochlear nerve in rats. Lateral suboccipital craniectomy and microsurgical preparation of the vestibulocochlear nerve were performed in 42 rats. Water pressures of 2-10 bar were applied, and the effect was microscopically evaluated. Auditory brainstem responses (ABRs) were used to define nerve function compared with preoperative values and the healthy contralateral side. The final anatomical preparation documented the morphological and histological effects of waterjet pressure on the nerve. In using up to 6 bar, the cochlear nerve was preserved in all cases. Eight bar moderately damaged the nerve surface. A 10-bar jet markedly damaged or even completely dissected the nerve. Time course analysis of the ABR demonstrated complete functional nerve preservation up to 6 bar after 6 weeks in all rats. Waterjet dissection with 8 bar was associated with a 60% recovery of ABR. In the 10-bar group, no recovery was seen. Microsurgical dissection of cranial nerves is possible using waterjet dissection while preserving both morphology and function. The aforementioned jet pressures are known to be effective in neurosurgical treatment of tumors. Thus, waterjet dissection may be useful in skull base surgery including dissection of cranial nerves from tumors. Further studies on this subject are encouraged.Journal of Neurosurgery 11/2008; 110(4):656-61. · 3.15 Impact Factor