Article
The retrosigmoid approach – complications, surgical obstacles and considerations in a large series of 540 procedures
Der retrosigmoidale Zugang Komplikationen, technische Besonderheiten und Überlegungen in einer großen Serie von 540 Zugängen
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Published: | May 25, 2022 |
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Outline
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Objective: Exposure of the posterior skull base and the cerebello-pontine angle is challenging due to strategic structures. The retrosigmoid approach (RSA) has turned out to be the workhorse approach for it. We report our experiences with RSAs.
Methods: We performed a retrospective chart review at a tertiary neurosurgical center between January 2007 and September 2020. We included all patients undergoing surgery through RSAs concentrating on surgical technique, postoperative outcome and complications.
Results: 540 RSAs were included: 15 (2.8%) epidermoid cysts, 9 (1.7%) hemangioblastomas, 9 (1.7%) cases of facial hemispasm, 71 (13.1%) cases of trigeminal neuralgia, 157 (29.1%) meningiomas, 49 (9.1%) metastases, 14 (2.6%) non-vestibular schwannomas, 180 (33.3%) vestibular schwannomas and 36 (6.7%) other separate pathologies. Median age was 59 years; 204 (37.8%) male and 336 (62.2%) female. Median approach surface was 7.7 cm2 with 355 (66.1%) osteoclastic and 182 (33.9%) osteoplastic craniotomies. Median tumor volume was 5.8 cm3. Gross total resection rate (+ Simpson I/II) was achieved in 339/450 (75.3%) cases. Postoperative complication rate was 25,3% (N =122). Tumor volume had a significant impact on postop. complications (P = 0.045), but did not sign. affect occurrence (P= 0,072) and number of postop. new deficits (P = 0.135). Tumor volume led to more extended craniotomies (P = 0,009). Extent of approach had a sign. impact on complications (P=0,049). No sign. correlation between craniotomy technique (osteoplastic/-clastic) and complications was found (P = 0,187) Extent of approach had no sign. impact on extent of resection (GTR/Simpson) (P = 0,155/0,275). Complications (P = 0,004), in particular hemorrhage (P = 0,019), CSF leaks (P=0,026) and hydrocephalus (P = 0,050) had sign. correlations with postop. new deficits.
Conclusion: The RSA has to be performed with respect, approach-related complications and morbidity are not to be neglected. Tumor size should not lead to bigger approaches at any cost, as postoperative complications may increase; individually tailored approaches are essential to obtain best possible postoperative outcome.