Retrosigmoidal Craniotomy for Vestibular Schwannoma Patients: Postoperative Cerebrospinal Fluid Leak

Abstract

Postoperative Cerebrospinal fluid (CSF) fistulas are one of the most important complications in the early period after vestibular schwannoma surgery. The aim of this study was to identify patients likely to develop CSF leaks using a retrospective analysis. Between January 2001 and December 2006, 420 patients underwent retrosigmoidal microsurgical tumor removal in a standardized procedure. Of these 420 patients, 363 underwent treatment for the first time, and 27 suffered from recurrent tumors. Twenty-six patients had bilateral tumors due to neurofibromatosis type 2, and four patients had previously undergone radiosurgical treatment. An analysis was performed to examine the incidence of postoperative CSF fistulas in all four groups. The incidence of CSF leakage was higher in the tumor recurrence group (11.1%) than in patients undergoing surgery for the first time (4.4%). There were no CSF fistulas in the neurofibromatosis type 2 group or in patients with preoperative radiosurgical treatment. Tumor size and male sex were identified as possible risk factors in a previous study. Low tumor grade, male sex, and surgery for recurrent tumors are significant risk factors for the development of CSF leaks.