2025 Poster Presentations
P461: VESTIBULAR SCHWANNOMA SURGERY. TREATMENT OF CEREBROSPINAL FLUID LEAK
Eduard Zverina, Prof, PhD; Dept. of ENT Head an Neck Surgery, Charles University
Introduction: Cerebrospinal fluid leak (CSFL) and intradural infection represent common complication after vestibular schwannoma (VS) surgery. The aim of the work was to show the minimally invasive method for its management and prevention of infectious complications.
Methods: There was a retrospective analysis of 700 patients undergoing retrosigmoid-transmeatal (RSA) VS microsurgery between 1997 - 2023 (90% grade III - IV tumors; all but 3 cases were radically removed). During the surgery drilled internal auditory canal and opened pneumatic system were sealed with muscle plug and tissue glue. Dura was closed first. Bony flap and pate were used for craniotomy defect closure. Cefalosporin 3rd generation were used perioperatively.
Results: Lateral variant of CSFL with epidural CSF collection occurred in 62,5%. after MRI examination. All had puncture, aspiration with eventual tissue glue injection ( 1- 6 applications) and wound compression. Less than 1% need reoperation. Medial variant of CSFL occurred in 0.6% cases were managed with wound re-exploration. During the period of 1- 26 years none of the operated patients had serious wound and intracranial infection.
Conclusions: Postoperative infection in case of VS RSA microsurgery is avoidable. The relatively conservative management of lateral CSFL with postoperative puncture, complete aspiration and tissue glue injection into the pseudomeningocoele solves this problem. Medial variant of CSFL need reoperation CSFL does not need any lumbar or ventricular drainage and shunts.