gms | German Medical Science

73. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Griechischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

29.05. - 01.06.2022, Köln

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

Meeting Abstract

  • presenting/speaker Amir Kaywan Aftahy - Klinikum rechts der Isar der TU München, Klinik und Poliklinik für Neurochirurgie, München, Deutschland
  • Ann-Kathrin Joerger - Klinikum rechts der Isar der TU München, Klinik und Poliklinik für Neurochirurgie, München, Deutschland
  • Sandra Hillebrand - Klinikum rechts der Isar der TU München, Klinik und Poliklinik für Neurochirurgie, München, Deutschland
  • Melanie Barz - Klinikum rechts der Isar der TU München, Klinik und Poliklinik für Neurochirurgie, München, Deutschland
  • Chiara Negwer - Klinikum rechts der Isar der TU München, Klinik und Poliklinik für Neurochirurgie, München, Deutschland
  • Bernhard Meyer - Klinikum rechts der Isar der TU München, Klinik und Poliklinik für Neurochirurgie, München, Deutschland
  • Jens Gempt - Klinikum rechts der Isar der TU München, Klinik und Poliklinik für Neurochirurgie, München, Deutschland
  • Benedikt Wiestler - Klinikum rechts der Isar der TU München, Neuroradiologie, München, Deutschland
  • Felix Harder - Klinikum rechts der Isar der TU München, Radiologie, München, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 73. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Griechischen Gesellschaft für Neurochirurgie. Köln, 29.05.-01.06.2022. Düsseldorf: German Medical Science GMS Publishing House; 2022. DocV010

doi: 10.3205/22dgnc010, urn:nbn:de:0183-22dgnc0108

Published: May 25, 2022

© 2022 Aftahy et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.


Outline

Text

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.