Author Topic: Supporting operations before/following retrosigmoid craniotomy  (Read 2446 times)

KNF

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Hello everyone,
My mother was recently diagnosed with ~2cm vestibular scwhannoma in left CPA.  We are currently trying to decide on a neurosurgeon (and accompanying neurotologist).   The three have all given roughly similar outlook and recommend retrosigmoid craniotomy with potential to drill into IAC (to be determined during surgery).  But there are a couple of differences in their approaches leading up to surgery and for the cranioplasty at the end of surgery.  I was wondering if others have experience with the different approaches and/or knowledge about which are more likely to provide the best outcome.
1)  One surgeon wants to place a lumbar drain the day before surgery to help reduce pressure and relax the brain to improve visualization and access.  The other surgeons say they very rarely use lumbar drain and don't think they will need it in this case.   On one hand, an extra procedure (with risks) to place the lumbar drain something we'd rather avoid, but if it can really improve chances for an excellent tumor removal and outcome, it may be worth it.
2)  Two surgeons use hydroxyapatite bone cement for the cranioplasty.  They do not replace the bone that they took out, but it seems that they use the cement to fill the void where the bone was.   They say this is an excellent technique to prevent CSF leaks and they have been doing it for a long time.  The other surgeon says he hates bone cement - he has seen infections and also deterioration of the cement from patients coming to him from other surgeons.  He prefers to replace the bone piece that is taken out during the craniotomy and secure it with small titatnium plates and screws (and minearized bone in the seam).   Just wondering what other people have had, or what you know about the benefits/disadvantages/ risks. 

I'd be grateful to hear any thoughts others may have on this.  Then again, I know there probably isn't a "right" answer on which way to go on either procedure.

My sincere sympathy for everyone touched by this tumor type - and all of the mental anguish and stress that it can create for patients and loved ones.   

Thank you.

v357139

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Re: Supporting operations before/following retrosigmoid craniotomy
« Reply #1 on: May 05, 2024, 07:52:54 pm »
Hi KNF.  Sorry for your mom.  In this craft, each doctor seems to have his favorite method.  Another way to evaluate this is to determine which teams are the most experienced.  Also you can ask people on this site for their experience with these doctors.  You can also use the search feature on this site and see what comments have come up on their names.  The most important thing is a very experienced team with a great track record.  Best regards.
Dx 2.6 cm Nov 2012, 35% hearing loss.  Grew to 3.5 cm Oct 2013.  Pre-op total hearing loss, left side tongue numb.  Translab Nov 2013 House Clinic.  Post-op no permanent facial or other issues.  Tongue much improved.  Great result!!

Greece Lover

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Re: Supporting operations before/following retrosigmoid craniotomy
« Reply #2 on: May 08, 2024, 10:03:20 am »
It is definitely true that all surgeons have their preferences.  I do wonder if a few things are getting confused here.  There are two times that bone gets dealt with in these surgeries. 
1. The craniotomy--that the hole they cut in your skull to get to the tumor.
2. the Interior auditory canal (IAC). 
there are different options for how to replace the bone from the craniotomy.  Some use titanium.  My surgeon used an absorbable plate system, so that over 6-9 months the things holding the bone flap in place are absorbed by the body as the bone heals, so now I  have not metal in my head.
The IAC, as I understand it, gets obliterated during surgery. Because it is so small, the just grind it away.  This is where the cement/bone wax comes in.  You seem to have confused the titanium plating to replace the craniotomy bone flap with the bone from the IAC.  I don't think they ever do that.  There may be other products than cement to fill in the IAC after tumor removal. (For me, the harvested some belly fat to put in the IAC, and then covered it all with "bone wax," whatever that is.)

I don't know if I"m making sense, but it does seem in your second point you can the craniotomy and IAC parts combined.

Vestibular Schwannoma 1.2 cm. Right side.
Middle fossa surgery at University of Iowa on May 9 2016.
Hearing saved.  Face is fine. Balance pretty darn good most days.
One year follow up MRI showed no tumor. 
Five year follow up showed no tumor, so I'm in the clear.