Intraoperative Cisternostomy during Cerebellopontine Angle Tumor Surgery: A single centre experience without Postoperative Cerebrospinal Fluid Diversion
DOI:
https://doi.org/10.12669/pjms.41.13(PINS-NNOS).13377Keywords:
Cerebellopontine angle, Brain tumors, Acoustic neuroma, Hydrocephalus, Cisternostomy, PakistanAbstract
Background and Objective: Cerebellopontine angle (CPA) is an important anatomical landmark hosting important neurovascular structures. Hydrocephalus presents a great challenge in CPA lesions management. We aimed to highlight the significance of intraoperative cisternostomy and without the need of preoperative and postoperative cerebrospinal fluid (CSF) diversion.
Methodology: This retrospective observational study was conducted at Punjab Institute of Neurosciences involving consecutive, single-surgeon led cases of CPA space occupying lesions (SOL) between 2022 and 2024. Data was collected for demographic and clinical presentation, extent of resection and the need for post-operative CSF diversion while making use of intraoperative cisternostomy in all cases.
Results: A male preponderance of 51.90% (42) patients was identified with an overall mean age of 39.13±13.18 years. Eighty-one patients underwent intra-operative cisternostomy of which 98.80% (80) cases were adult patients. The commonest clinical manifestations at presentation were headache in 91.4% (74) and sensorineural hearing loss in 92.60% (75) cases. Mean preoperative Glasgow coma scale (GCS) score was 14.9±0.6. Mean pre-operative KPS (Karnofsky performance status) score was 81.35 ± 13.1. About 91.40% (74) patients underwent gross total resection. Schwannoma was seen in 80.2% (65) patients making it the most common CPA pathology. Mean immediate postoperative GCS was 13.93±2.26. Mean postoperative KPS score was 78.76±15.11. Only 13.80% (12) patients required post-operative CSF diversion in the form of ventriculoperitoneal (VP) shunt during first year of follow up.
Conclusion: Retrosigmoid approach with intraoperative cisternostomy for excision of cerebellopontine angle lesions is a safe and efficient approach with better outcomes, mitigating the need for pre-operative and post-operative CSF diversion.
