Skull base reconstruction after the vestibular schwannoma surgery

Incidence of the vestibular schwannoma in the Czech Republic is around 200 newly diagnosed patients per year. About half of these are observed, others are operated, irradiated by stereotactic radiosurgery or treated with biological treatment.

The most common postoperative complications include paresis of the facial nerve and cerebrospinal fluid (CSF) leak. Post-operative liquorrhea (lateral, medial variant) means an increased risk of developing meningitis endangering the patient's life. Properly reconstruction of the inner ear canal after removal the tumor´s intrameatal portion, suture of the dura mater and bone closure are essential aspects to prevent CSF leakage.

The aim of the work was to retrospectively evaluate a set of patients operated at the Department of Otorhinolaryngology and Head and Neck Surgery, 1st Faculty of Medicine, Charles University in Prague, Motol University Hospital in 1997-2018. We wanted to find out the total number of patients with presence and type of CSF leak, management of treatment, incidence of meningitis and other complications. The total number of operated patients was 609. 279 of them had liquorrhea. The most common type of CSF leak was the lateral variant, in 269 cases. The medial variant occurred only in 10 cases. In the lateral variant 268 patients (99.6 %) were treated conservatively, while all with the medial variant resulted to surgical revision of the wound in total anesthesia. Meningitis has not been demonstrated in any patient.

The high number of cases of liquorrhea is mainly attributed to very active and targeted search for its occurrence. Probably becouse of even a minor CSF leak is detected and treated, we have not noticed a complicaton with meningitis on our department for more than 20 years.

Poster-PDF A-1262.PDF

Publication History

Article published online:
10 June 2020