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The Bigger the Better? Analysis of Surgical Complications and Outcome of the Retrosigmoid Approach in 449 Oncological Cases

INTRODUCTION: Exposure of the posterior skull base and the cerebellopontine angle is challenging due to important neurovascular structures. The retrosigmoid approach (RSA) has become the standard method used in surgery. We report our experiences with RSAs regarding technical obstacles, complications...

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Autores principales: Aftahy, Amir Kaywan, Jörger, Ann-Kathrin, Hillebrand, Sandra, Harder, Felix N., Wiestler, Benedikt, Bernhardt, Denise, Combs, Stephanie E., Meyer, Bernhard, Negwer, Chiara, Gempt, Jens
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9294506/
https://www.ncbi.nlm.nih.gov/pubmed/35865465
http://dx.doi.org/10.3389/fonc.2022.938703
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author Aftahy, Amir Kaywan
Jörger, Ann-Kathrin
Hillebrand, Sandra
Harder, Felix N.
Wiestler, Benedikt
Bernhardt, Denise
Combs, Stephanie E.
Meyer, Bernhard
Negwer, Chiara
Gempt, Jens
author_facet Aftahy, Amir Kaywan
Jörger, Ann-Kathrin
Hillebrand, Sandra
Harder, Felix N.
Wiestler, Benedikt
Bernhardt, Denise
Combs, Stephanie E.
Meyer, Bernhard
Negwer, Chiara
Gempt, Jens
author_sort Aftahy, Amir Kaywan
collection PubMed
description INTRODUCTION: Exposure of the posterior skull base and the cerebellopontine angle is challenging due to important neurovascular structures. The retrosigmoid approach (RSA) has become the standard method used in surgery. We report our experiences with RSAs regarding technical obstacles, complications, and approach-related outcomes. MATERIALS AND METHODS: We performed a retrospective chart review at a tertiary neurosurgical center between January 2007 and September 2020. We included all patients undergoing surgery for oncologic lesions through RSAs, concentrating on surgical technique, postoperative outcome, and complications. RESULTS: A total of 449 RSAs were included. The median age at the time of surgery was 58 years; 168 (37.4%) were male and 281 (62.6%) were female. The median approach surface was 7.8 cm(2). The median tumor volume was 5.9 cm(3). The median Clavien–Dindo grade was 2, the total complication rate was 28.7%, and gross total resection (GTR) was 78.8%. Findings revealed that tumor volume had no significant impact on postoperative complications in general (p = 0.086) but had a significant impact on postoperative hemorrhage (p = 0.037) and hydrocephalus (p = 0.019). Tumor volume was significant for several preoperative symptoms (p < 0.001). The extent of the approach had no significant impact on complications in general (p = 0.120) but was significant regarding postoperative cerebrospinal fluid (CSF) leaks (p = 0.008). Craniotomy size was not significant regarding GTR (p = 0.178); GTR rate just missed significant correlation with tumor volume (p = 0.056). However, in the case of vestibular schwannomas, the size of craniotomy was important for GTR (p = 0.041). CONCLUSION: Tumor volume has an important impact on preoperative symptoms as well as on postoperative complications. Although the extent of the craniotomy barely missed significance regarding GTR, a correlation can be assumed. Thus, the extent of craniotomy should be taken into presurgical consideration, especially in the case of postoperative CSF leaks. Regarding vestibular schwannomas, craniotomy size plays an important role in achieving satisfactory oncological outcomes. Different approaches should be selected where necessary regarding superior resection rates.
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spelling pubmed-92945062022-07-20 The Bigger the Better? Analysis of Surgical Complications and Outcome of the Retrosigmoid Approach in 449 Oncological Cases Aftahy, Amir Kaywan Jörger, Ann-Kathrin Hillebrand, Sandra Harder, Felix N. Wiestler, Benedikt Bernhardt, Denise Combs, Stephanie E. Meyer, Bernhard Negwer, Chiara Gempt, Jens Front Oncol Oncology INTRODUCTION: Exposure of the posterior skull base and the cerebellopontine angle is challenging due to important neurovascular structures. The retrosigmoid approach (RSA) has become the standard method used in surgery. We report our experiences with RSAs regarding technical obstacles, complications, and approach-related outcomes. MATERIALS AND METHODS: We performed a retrospective chart review at a tertiary neurosurgical center between January 2007 and September 2020. We included all patients undergoing surgery for oncologic lesions through RSAs, concentrating on surgical technique, postoperative outcome, and complications. RESULTS: A total of 449 RSAs were included. The median age at the time of surgery was 58 years; 168 (37.4%) were male and 281 (62.6%) were female. The median approach surface was 7.8 cm(2). The median tumor volume was 5.9 cm(3). The median Clavien–Dindo grade was 2, the total complication rate was 28.7%, and gross total resection (GTR) was 78.8%. Findings revealed that tumor volume had no significant impact on postoperative complications in general (p = 0.086) but had a significant impact on postoperative hemorrhage (p = 0.037) and hydrocephalus (p = 0.019). Tumor volume was significant for several preoperative symptoms (p < 0.001). The extent of the approach had no significant impact on complications in general (p = 0.120) but was significant regarding postoperative cerebrospinal fluid (CSF) leaks (p = 0.008). Craniotomy size was not significant regarding GTR (p = 0.178); GTR rate just missed significant correlation with tumor volume (p = 0.056). However, in the case of vestibular schwannomas, the size of craniotomy was important for GTR (p = 0.041). CONCLUSION: Tumor volume has an important impact on preoperative symptoms as well as on postoperative complications. Although the extent of the craniotomy barely missed significance regarding GTR, a correlation can be assumed. Thus, the extent of craniotomy should be taken into presurgical consideration, especially in the case of postoperative CSF leaks. Regarding vestibular schwannomas, craniotomy size plays an important role in achieving satisfactory oncological outcomes. Different approaches should be selected where necessary regarding superior resection rates. Frontiers Media S.A. 2022-07-05 /pmc/articles/PMC9294506/ /pubmed/35865465 http://dx.doi.org/10.3389/fonc.2022.938703 Text en Copyright © 2022 Aftahy, Jörger, Hillebrand, Harder, Wiestler, Bernhardt, Combs, Meyer, Negwer and Gempt https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Oncology
Aftahy, Amir Kaywan
Jörger, Ann-Kathrin
Hillebrand, Sandra
Harder, Felix N.
Wiestler, Benedikt
Bernhardt, Denise
Combs, Stephanie E.
Meyer, Bernhard
Negwer, Chiara
Gempt, Jens
The Bigger the Better? Analysis of Surgical Complications and Outcome of the Retrosigmoid Approach in 449 Oncological Cases
title The Bigger the Better? Analysis of Surgical Complications and Outcome of the Retrosigmoid Approach in 449 Oncological Cases
title_full The Bigger the Better? Analysis of Surgical Complications and Outcome of the Retrosigmoid Approach in 449 Oncological Cases
title_fullStr The Bigger the Better? Analysis of Surgical Complications and Outcome of the Retrosigmoid Approach in 449 Oncological Cases
title_full_unstemmed The Bigger the Better? Analysis of Surgical Complications and Outcome of the Retrosigmoid Approach in 449 Oncological Cases
title_short The Bigger the Better? Analysis of Surgical Complications and Outcome of the Retrosigmoid Approach in 449 Oncological Cases
title_sort bigger the better? analysis of surgical complications and outcome of the retrosigmoid approach in 449 oncological cases
topic Oncology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9294506/
https://www.ncbi.nlm.nih.gov/pubmed/35865465
http://dx.doi.org/10.3389/fonc.2022.938703
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