Title: Complications of the translabyrinthine approach for the removal of acoustic neuromas.

Author: Mass SC; Wiet RJ; Dinces E
Address: Department of Otolaryngology-Head and Neck Surgery, McGaw Medical Center, Northwestern University, Chicago, Ill, USA.

Source: Arch Otolaryngol Head Neck Surg, 125(7):801-4 1999 Jul


OBJECTIVE: To report the complications that occurred during a large series of surgical procedures for the removal of acoustic neuromas using the translabyrinthine approach. DESIGN: Retrospective analysis.

SETTING: Neuro-otology practice with academic affiliation. Procedures were performed at either a university medical center or a community hospital in conjunction with a neurosurgery team. PATIENTS: A total of 258 patients (142 men, 116 women; mean age, 51 years) underwent the translabyrinthine approach during a 14-year period. All patients had a histologically proven diagnosis of acoustic neuroma.

RESULTS: There were no deaths. There were 3 cases (1.1%) of neurovascular compromise. There were 20 cases (7.8%) of cerebrospinal fluid leak, 16 (80%) of which presented as rhinorrhea and 4 (20%) as incisional leaks. The leaks at the incision responded to conservative management, while rhinorrhea usually required more aggressive means of closure. Four patients (1.6%) were diagnosed as having bacterial meningitis.

Complete gross tumor removal was not achieved in 4 patients (1.6%). Facial nerve function, as measured by the House-Brackmann system, was recorded in all patients at 1 year: 76% had a score of I or II; 18%, a score of III or IV; and 6%, a score of V or VI. Other complications included 3 cases of pneumonia, 1 case of severe gastric hemorrhage, and 1 case of wound infection.

CONCLUSIONS: The results of this series generally agree with those of other large series and demonstrate the safety and effectiveness of the translabyrinthine approach in excising acoustic neuromas.

Inez's note: I'm afraid the 1999 ANA survey does not lead me to conclude that the translab approach is safe and effective; the potential for nerve damage with any type of surgery for acoustic neuroma is too great.

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