Association of Postoperative Sigmoid Sinus Occlusion and Cerebrospinal Fluid Leak in Translabyrinthine Surgery. (29th January 2023)

• Record Type: Journal Article
• Authors: Freeman, Michael H.; Cass, Nathan D.; Berndt, David M.; Kloosterman, Nicole; Poulos, Eric A.; Perkins, Elizabeth L.; O'Malley, Matthew R.; Tawfik, Kareem O.; Bennett, Marc L.; Aulino, Joseph M.; Haynes, David S.
• Is Part Of: Otolaryngology--head and neck surgery. Volume 168:Number 3(2023)
• Page Start: 435
• Page End: 442
• Publication Date: 2023-01-29
• Subjects: skull base surgery -- complications -- cerebrospinal fluid leak -- vestibular schwannoma; Head -- Surgery -- Periodicals; Neck -- Surgery -- Periodicals; Otolaryngology -- Periodicals; 617.51
• DOI: 10.1177/01945998221102817
• Languages: English
• ISSNs: 0194-5998

Abstract

Abstract: Objective: To characterize the incidence of sigmoid sinus occlusion (SSO) following translabyrinthine (TL) surgery for posterior fossa tumor resection and determine the association with cerebrospinal fluid (CSF) leak. Study Design: Retrospective case series. Setting: Tertiary referral center. Methods: Patients undergoing TL surgery for vestibular schwannoma from 2012 to 2020 were included. Demographic data, medical history, preoperative tumor length and volume, and postoperative complications including CSF leak were recorded. Neuroradiology review of postoperative magnetic resonance imaging was used to determine the presence or absence of flow through the sigmoid sinus. Results: Of 205 patients undergoing TL, 21 (10.2%) experienced CSF leak postoperatively. Overall 56 (27%) demonstrated SSO on immediate postoperative magnetic resonance imaging. CSF leaks were more likely in those with SSO (19.6%) than those without SSO (6.7%; odds ratio, 3.54 [95% CI, 1.25‐10.17]). Tumor volume and body mass index were not significantly associated with CSF leak. In total, 105 (51%) patients had some degree of sigmoid sinus thrombosis, but nonocclusive thrombosis was not associated with CSF leak. Conclusion: SSO after TL approaches is common and appears to be significantly associated with postoperative CSF leak development. Minimizing manipulation of the sigmoid sinus during TL surgery and compression after surgery may have a role in preventing CSF leak.