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. 2022 Jul 5:12:938703.
doi: 10.3389/fonc.2022.938703. eCollection 2022.

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

Amir Kaywan Aftahy  1 , Ann-Kathrin Jörger  1 , Sandra Hillebrand  1 , Felix N Harder  2 , Benedikt Wiestler  3 , Denise Bernhardt  4   5 , Stephanie E Combs  4   5   6 , Bernhard Meyer  1 , Chiara Negwer  1 , Jens Gempt  1
Affiliations

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

Amir Kaywan Aftahy et al. Front Oncol. .

Abstract

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 cm2. The median tumor volume was 5.9 cm3. 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.

Keywords: neurooncology; operative technique; retrosigmoid approach; skull base surgery; surgical technical improvement.

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Conflict of interest statement

JG and BM work as consultants for Brainlab (Brainlab AG, Feldkirchen). In addition, BM works as a consultant for Medtronic, Spineart, Icotec, Relievant, and DePuy/Synthes. In these firms, BM acts as a member of the advisory board. Furthermore, BM reports a financial relationship with Medtronic, Ulrich Medical, Brainlab, Spineart, Icotec, Relievant, and DePuy/Synthes. He received personal fees and research grants for clinical studies from Medtronic, Ulrich Medical, Brainlab, Icotec, and Relievant. All this happened independently of the submitted work. BM holds royalties/patents for Spineart. All named potential conflicts of interest are unrelated to this study. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
C-shaped incision used in the RSA. After craniotomy and retraction of the cerebellum, the tumor becomes visible within the cerebellopontine angle. The anterior edge of craniotomy is placed immediately behind the sigmoid sinus and just inferior to the lower margin of the transverse sinus.
See this image and copyright information in PMC

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