• World Neurosurg · Mar 2016

    Improved postoperative facial nerve and hearing function in retro- sigmoid vestibular schwannoma surgery significantly associated with semi- sitting position.

    • Karl Roessler, Maximilian Krawagna, Barbara Bischoff, Stefan Rampp, Oliver Ganslandt, Heinrich Iro, Hubert Schmitt, and Michael Buchfelder.
    • Department of Neurosurgery, University Hospital Erlangen, Erlangen, Germany. Electronic address: karl.roessler@uk-erlangen.de.
    • World Neurosurg. 2016 Mar 1; 87: 290-7.

    ObjectiveThe pros and cons of semisitting positioning (SSP) versus lateral, horizontal positioning (LP) during retrosigmoid vestibular schwannoma (VS) surgery, especially concerning postoperative cranial nerve and brain stem preservation, are under continuous discussion.MethodsIn a single-center retrospective cohort study, 30 VSs operated on in SSP compared with 30 operated on in LP with comparable demography were analyzed. During SSP surgery, transesophageal echocardiographic monitoring for venous air embolism was used continuously. Electrophysiologic cranial nerve monitoring was used in both groups.ResultsLength of surgery was significantly different between both groups: 183 minutes mean in SSP surgery versus 365 minutes mean in LP surgery (P = 0.0001). Postoperative rates of facial palsy and hearing loss were also significantly different. Six months postoperatively, 63% had normal facial nerve function after SSP surgery, whereas in LP surgery, 40% had no facial palsy (P = 0.02). Hearing preservation rate was also significantly different: 44% in SSP surgery compared with 14% in LP surgery who had preserved hearing (P = 0.006). Because of cerebrospinal fluid leaks, there were 3 operative revisions in the LP group (10%) and 1 (3.3%) in the SSP group. A clinically insignificant venous air embolism rate was found in 3.3% of patients (1/30) during SSP surgery. The neurologic outcome after 6 months was 1.2 on the Rankin Scale in the LP group and 1.0 in the SSP group, with zero mortality.ConclusionsSSP compared with LP surgery was associated with significantly shorter operation time and better facial and cochlear nerve function in VS surgery postoperatively, without differences in complication rates.Copyright © 2016 Elsevier Inc. All rights reserved.

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