Artikel
Does papaverine intracisternal instillation improve hearing preservation in vestibular schwannoma surgery? A retrospective study in 101 patients
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Autoren
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Giulia Del Moro
- Department of Neurosurgery, Eberhard Karls University, Tübingen, Germany; Department of Neurosurgery, Università degli Studi di Padova, Padova, Italy
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Florian H. Ebner
- Department of Neurosurgery, Eberhard Karls University, Tübingen, Germany
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Marina Liebsch
- Department of Neurosurgery, Eberhard Karls University, Tübingen, Germany
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Karlheinz G. Decker
- Department of Neurosurgery, Eberhard Karls University, Tübingen, Germany
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Florian Roser
- Department of Neurosurgery, Eberhard Karls University, Tübingen, Germany; Neurological Institute, Cleveland Clinic, Abu Dhabi, United Arab Emirates
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Marcos S. Tatagiba
- Department of Neurosurgery, Eberhard Karls University, Tübingen, Germany
| Veröffentlicht: | 2. Juni 2015 |
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Gliederung
Text
Objective: Papaverine use during vestibular schwannoma (VS) resection has been suggested in order to preserve facial and acoustic nerve function (consensus of experts). Besides its common use in VS surgery, to date, its efficacy in hearing preservation has not been clinically proven. In contrast, several side effects have been reported following intracisternal instillation, such as facial nerve palsy, acute auditory nerve toxicity, hypotension, bradycardia and third nerve palsy.
The aim of this study is to assess safety and efficacy of papaverine topical application in VS surgery.
Method: All patients that underwent surgery for VS from June 2013 to May 2014 in our department were retrospectively reviewed for intraoperative papaverine topical use and postoperative hearing preservation according to pre, intra and post-operative clinical and neurophysiological data. Statistical analyses were performed using IBM SPSS Statistics 22.
Results: Safety
During 12 months 101 patients underwent VS surgery through a retrosigmoid approach. Topical papaverine instillation was performed in 37 cases (36.5%) following an intraoperative AEPs or facial MEPs worsening. Post-operative facial nerve function was not significantly different between treated and untreated group (p = 0.25). None of the treated patients experienced intraoperative hypotension, bradycardia or heart arrest following papaverine intracisternal instillation. Intraoperative papaverine use was not associated to surgical complications (p = 0.36), longer ICU need or longer hospitalisation (p = 0.27 and p = 0.28 respectively).
Efficacy
Sixty-one patients had a pre-operative preserved hearing, 57% of them preserved it after surgery. Papaverine was used in 50% of the cases with preserved pre-operative hearing-function. Despite its administration in case of AEPs instability (p = 0.04), 71.5% of the patients receiving topical papaverine instillation preserved hearing compared to 52% in the non-papaverine group. Adjusting for intraoperative AEPs instability, papaverine use was significantly associated to a higher hearing preservation rate (p = 0.05) independently from tumour classification (p = 0.47).
Conclusions: To our knowledge this is the first study proving papaverine instillation safety and efficacy in hearing preservation during VS surgery. Further studies are needed in order to confirm these retrospective observations.
