A Study of Perioperative Lumbar Cerebrospinal Fluid Pressure in Patients Undergoing Acoustic Neuroma Surgery

Laing, Rodney; Śmielewski, Piotr; Czosnyka, Marek; Quaranta, Nicola; Moffat, David A.

doi:10.1055/s-2000-9330

Cited by 13 publications

(8 citation statements)

References 11 publications

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“…We suggest, therefore, that there may be a unifying organic basis to many of the complex symptoms and problems following skull base surgery, including headache and CSF leaks, in the form of iatrogenic compromise to cranial venous outflow. Moreover, we suggest that a CSF leak represents a pathological, but essentially homeostatic, response to raised intracranial pressure in this situation and that while meticulous surgical technique may reduce its incidence, 14 if cranial venous outflow compromise is left untreated, this may simply mean that one set of symptoms are exchanged for another. 37…”

Section: Discussionmentioning

confidence: 98%

“…[11][12][13] One could speculate further that a similar mechanism might apply in patients who show no hydrocephalus preoperatively, the underlying problem eventually declaring itself as delayed healing of an iatrogenic dural defect. 14 We have seen narrowing of the sigmoid sinus where it crosses the craniectomy defect following vestibular schwannoma surgery and published a report in which repair of this narrowing by stenting brought about resolution of postoperative headache. 15 Similarly, we have published a report in which jugular venous narrowing was responsible for a spontaneous CSF leak which resolved after stenting.…”

Section: Introductionmentioning

confidence: 99%

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Headache, Cerebrospinal Fluid Leaks, and Pseudomeningoceles after Resection of Vestibular Schwannomas: Efficacy of Venous Sinus Stenting Suggests Cranial Venous Outflow Compromise as a Unifying Pathophysiological Mechanism

et al. 2019

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Background Regardless of the operative approach, headache, cerebrospinal fluid (CSF) leaks, and pseudomeningoceles remain disproportionately common problems after surgery for vestibular schwannomas and have a significant negative impact on quality of life and potential to return to full employment. Recent work has raised the possibility that these problems may, in part, be related to acquired obstruction of cranial venous outflow. This article explores this idea further with respect to a group of patients with severe and intractable symptoms. Objective The main objective of this article is to describe our experience diagnosing, investigating, and treating cranial venous outflow obstruction following translabyrinthine resection of vestibular schwannomas. Methods Retrospective review of all patients (n = 9) at our institution referred for sigmoid sinus stenting following translabyrinthine surgery. Results Headache resolved or improved after sigmoid stenting in all five patients in whom it was the primary symptom. CSF leak was the primary problem in two patients. In one, the leak was unchanged, but headache improved. In the other, the leak resolved, and headache improved. Two patients had symptomatic pseudomeningoceles and both resolved Conclusion Assuming a meticulous approach to wound closure, a CSF leak following surgery for vestibular schwannoma can be viewed as a pathological, but essentially homeostatic, response to raised intracranial pressure caused by acquired obstruction to cranial venous outflow. Postoperative headache (from high or low intracranial pressure) and CSF leaks, therefore, may all respond to measures aimed at eliminating the obstructing lesion.

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Section: Discussionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

Headache, Cerebrospinal Fluid Leaks, and Pseudomeningoceles after Resection of Vestibular Schwannomas: Efficacy of Venous Sinus Stenting Suggests Cranial Venous Outflow Compromise as a Unifying Pathophysiological Mechanism

et al. 2019

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“…Perioperative lumbar drainage has been shown to be useful in preventing CSF leak after retrosigmoid approach. (22) Laing and Moffat (23) showed that intracranial CSF pressure rises immediately after posterior fossa surgery and normalizes after 48 hours, with impaired cerebrospinal fluid absorption theorized to be the cause. Elevation in CSF pressure can result in CSF egress around the tract of the ABI electrode cable into the subgaleal space, resulting in pseudomeningocele and CSF leak.…”

Section: Discussionmentioning

confidence: 99%

Initial Results of a Safety and Feasibility Study of Auditory Brainstem Implantation in Congenitally Deaf Children

Wilkinson

Eisenberg²,

Krieger³

et al. 2017

Otology &Amp; Neurotology

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Objective To determine the safety and feasibility of the auditory brainstem implant (ABI) in congenitally deaf children with cochlear aplasia and/or cochlear nerve deficiency. Study Design Phase I feasibility clinical trial of surgery in 10 children, ages 2 to 5 years, over a 3 year period. Setting Tertiary children’s hospital and university-based pediatric speech/language/hearing center. Intervention(s) ABI implantation and post-surgical programming. Main outcome measure(s) The primary outcome measure is the number and type of adverse events during ABI surgery and post-surgical follow-up, including behavioral mapping of the device. The secondary outcome measure is access to and early integration of sound. Results To date, nine children are enrolled. Five children have successfully undergone ABI surgery and postoperative behavioral programming. Three children were screen failures, and one child is currently undergoing candidacy evaluation. Expected adverse events have been documented in three of the five children who received the ABI. One child experienced a cerebral spinal fluid (CSF) leak, which resolved with lumbar drainage. One child demonstrated vestibular side effects during device programming, which resolved by deactivating one electrode. One child experienced postoperative vomiting resulting in an abdominal radiograph. Four children have completed their 1-year followup and have speech detection thresholds of 30 to 35 dB HL. Scores on the IT-MAIS/MAIS range from 8 to 31 (out of a total of 40), and the children are demonstrating some ability to discriminate between closed-sets words that differ by number of syllables (pattern perception). Conclusions ABI surgery and device activation appears to be safe and feasible in this preliminary cohort.

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“…3 The authors reported that 24 hours after surgery, all patients showed a statistically significant rise in CSF pressure from normal levels with an objective decrease in the compliance of the CSF compartment. However, this CSF pressure increase completely reversed within 48 hours of surgery, and the CSF pressure fell below the preoperative level over postoperative days 2 through 6 without any medical intervention or CSF drainage.…”

Section: Discussionmentioning

confidence: 99%

“…Consistent with basic fluid dynamics, CSF will flow from the relatively high intracranial pressure region to the relatively low-pressure regions of the eustachian tube, middle ear space, or dehiscence in the periosteal or skin incisions. 2 To characterize the intracranial CSF pressures following AN microsurgery, Laing et al 3 measured changes in CSF pressure and cerebrovascular hemodynamics following AN microsurgery in humans. All patients showed a statistically significant rise in CSF pressure from normal levels with complete reversal within 48 hours of surgery.…”

Section: Introductionmentioning

confidence: 99%

Preoperative Lumbar Drain Use During Acoustic Neuroma Surgery and Effect on CSF Leak Incidence

Crowson

Cunningham

Moses

et al. 2015

Ann Otol Rhinol Laryngol

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Objective: To determine if preoperative lumbar drain (LD) use reduces the incidence of postoperative cerebrospinal fluid (CSF) leak in patients undergoing acoustic neuroma resection. Methods: Retrospective review of 282 patients presenting for acoustic neuroma resection between 2005 and 2014. Results: Two hundred and eighty-two patients had a mean tumor size of 19.1 mm ± 10.2 mm. Twenty-nine (10.3%) patients developed a postoperative CSF leak. Two hundred and twenty patients (78.0%) received a preoperative LD, and 20 (9.1%) developed a CSF leak. Sixty-two (22.0%) patients did not receive a preoperative LD, and 9 (14.5%) developed a CSF leak. No significant difference in CSF leak frequency was observed with use versus no use of a LD (P = .23). Fifteen (5.3%) patients with an LD placed had a complication related to the LD. No significant difference in CSF leak frequency was observed with patient age, neurofibromatosis type-2 diagnosis, tumor size, or sidedness. Conclusions: Postoperative CSF leaks are among the most common complications of acoustic neuroma microsurgery. No formal guidelines exist for elective placement of a preoperative LD to lower the incidence of CSF leaks. Our reported CSF leak incidence with preoperative LD placement is not significantly lower than without LD use, and there is a complication rate associated with LD use.

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A Study of Perioperative Lumbar Cerebrospinal Fluid Pressure in Patients Undergoing Acoustic Neuroma Surgery

Cited by 13 publications

References 11 publications

Headache, Cerebrospinal Fluid Leaks, and Pseudomeningoceles after Resection of Vestibular Schwannomas: Efficacy of Venous Sinus Stenting Suggests Cranial Venous Outflow Compromise as a Unifying Pathophysiological Mechanism

Headache, Cerebrospinal Fluid Leaks, and Pseudomeningoceles after Resection of Vestibular Schwannomas: Efficacy of Venous Sinus Stenting Suggests Cranial Venous Outflow Compromise as a Unifying Pathophysiological Mechanism

Initial Results of a Safety and Feasibility Study of Auditory Brainstem Implantation in Congenitally Deaf Children

Preoperative Lumbar Drain Use During Acoustic Neuroma Surgery and Effect on CSF Leak Incidence

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