Acoustic Neuroma

Meyer, Scott A.; Post, Kalmon D.

doi:10.1016/b978-1-4160-5316-3.00136-2

Cited by 1 publication

(2 citation statements)

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“…Within our data, the choice to include a graft did vary based on the surgical approach. There was an increased trend of incorporating intraoperative fat grafts for TL approaches, though this was markedly lower (60.2%) than we expected, given the relative consensus within the neurosurgical literature around fat grafting with employment of the TL approach [ 20 ]. The lower than expected rate of fat grafting in TL procedures may be a result of varying institutional coding practices.…”

Section: Discussionmentioning

confidence: 95%

“…Prior work has reported that high volume centers achieve a lower average cost of hospitalization [ 18 - 19 ]. Low volume surgeons, using the more versatile retrosigmoid, may encounter a higher complication rate, potentially leading to the increased use of hospital resources not available in the MarketScan database [ 20 ]. Viewed collectively, our findings can inform practitioners by determining the composite risks of AN surgery in the broader neurosurgical community, as opposed to evaluating results from just one or a few centers.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Retrosigmoid Versus Translabyrinthine Approach for Acoustic Neuroma Resection: An Assessment of Complications and Payments in a Longitudinal Administrative Database

Cole

Veeravagu

Zhang

et al. 2015

Cureus

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ObjectRetrosigmoid (RS) and translabyrinthine (TL) surgery remain essential treatment approaches for symptomatic or enlarging acoustic neuromas (ANs). We compared nationwide complication rates and payments, independent of tumor characteristics, for these two strategies.MethodsWe identified 346 and 130 patients who underwent RS and TL approaches, respectively, for AN resection in the 2010-2012 MarketScan database, which characterizes primarily privately-insured patients from multiple institutions nationwide.ResultsAlthough we found no difference in 30-day general neurological or neurosurgical complication rates, in TL procedures there was a decreased risk for postoperative cranial nerve (CN) VII injury (20.2% vs 10.0%, CI 0.23–0.82), dysphagia (10.4% vs 3.1%, CI 0.10–0.78), and dysrhythmia (8.4% vs 2.3%, CI 0.08–0.86). Overall, there was no difference in surgical repair rates of CSF leak; however, intraoperative fat grafting was significantly higher in TL approaches (19.8% vs 60.2%, CI 3.95–9.43). In patients receiving grafts, there was a trend towards a higher repair rate after RS approach, while in those without grafts, there was a trend towards a higher repair rate after TL approach. Median total payments were $16,856 higher after RS approaches ($67,774 vs $50,918, p < 0.0001), without differences in physician or 90-day postoperative payments.Conclusions Using a nationwide longitudinal database, we observed that the TL, compared to RS, approach for AN resection experienced lower risks of CN VII injury, dysphagia, and dysrhythmia. There was no significant difference in CSF leak repair rates. The payments for RS procedures exceed payments for TL procedures by approximately $17,000. Data from additional years and non-private sources will further clarify these trends.

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%