Roethlisberger, Michel and Eberhard, Noemi Elisabeth and Rychen, Jonathan and Al-Zahid, Saif and Jayapalan, Ronie Romelean and Zweifel, Christian and Karuppiah, Ravindran and Waran, Vicknes (2023) Supratentorial cerebrospinal fluid diversion using image-guided trigonal ventriculostomy during retrosigmoid craniotomy for cerebellopontine angle tumors. Frontiers in Surgery, 10. ISSN 2296-875X, DOI https://doi.org/10.3389/fsurg.2023.1198837.
Full text not available from this repository.Abstract
BackgroundCerebellar contusion, swelling and herniation is frequently encoutered upon durotomy in patients undergoing retrosigmoid craniotomy for cerebellopontine angle (CPA) tumors, despite using standard methods to obtain adequate cerebellar relaxation.ObjectiveThe aim of this study is to report an alternative cerebrospinal fluid (CSF)-diversion method using image-guided ipsilateral trigonal ventriculostomy.MethodsSingle-center retro- and prospective cohort study of n = 62 patients undergoing above-mentioned technique. Prior durotomy, CSF-diversion was performed to the point where the posterior fossa dura was visibly pulsatile. Outcome assessment consisted of the surgeon's intra- and postoperative clinical observations, and postoperative radiological imaging.ResultsFifty-two out of n = 62 (84%) cases were eligible for analysis. The surgeons consistently reported successful ventricular puncture and a pulsatile dura prior durotomy without cerebellar contusion, swelling or herniation through the dural incision in n = 51/52 (98%) cases. Forty-nine out of n = 52 (94%) catheters were placed correctly within the first attempt, with the majority of catheter tips (n = 50, 96%) located intraventricularly (grade 1 or 2). In n = 4/52 (8%) patients, postoperative imaging revealed evidence of a ventriculostomy-related hemorrhage (VRH) associated with an intracerebral hemorrhage n = 2/52 (4%)] or an isolated intraventricular hemorrhage n = 2/52 (4%)]. However, these hemorrhagic complications were not associated with neurological symptoms, surgical interventions or postoperative hydrocephalus. None of the evaluated patients demonstrated radiological signs of upward transtentorial herniation.ConclusionThe method described above efficiently allows CSF-diversion prior durotomy to reduce cerebellar pressure during retrosigmoid approach for CPA tumors. However, there is an inherent risk of subclinical supratentorial hemorrhagic complications.
| Item Type: | Article |
|---|---|
| Funders: | UNSPECIFIED |
| Uncontrolled Keywords: | ventriculostomy; cerebrospinal fluid diversion; trigonal; retrosigmoid craniotomy; cerebellopontine angle; image guided surgery; hemorrhage; upward transtentorial herniation |
| Subjects: | R Medicine > R Medicine (General) |
| Divisions: | Faculty of Medicine > Surgery Department Universiti Malaya Medical Centre (UMMC) |
| Depositing User: | Ms. Juhaida Abd Rahim |
| Date Deposited: | 29 Jul 2025 01:09 |
| Last Modified: | 29 Jul 2025 01:09 |
| URI: | http://eprints.um.edu.my/id/eprint/50779 |
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