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Durmuş YE, Kaval B, Demirgil BT, Gökalp E, Gurses ME, Varol E, Gonzalez-Lopez P, Cohen-Gadol A, Gungor A. Dynamic Lateral Semisitting Position for Supracerebellar Approaches: Technical Note and Case Series. Oper Neurosurg (Hagerstown) 2023; 25:103-111. [PMID: 37255298 DOI: 10.1227/ons.0000000000000758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 03/16/2023] [Indexed: 06/01/2023] Open
Abstract
BACKGROUND It has always been a matter of debate which position is ideal for the supracerebellar approach. The risk of venous air embolism (VAE) is the major deterrent for surgeons and anesthesiologists, despite the fact that sitting and semisitting positions are commonly used in these operations. OBJECTIVE To demonstrate a reduction on the risk of VAE and tension pneumocephalus throughout the operation period while taking advantages of the semisitting position. METHODS In this study, 11 patients with various diagnoses were operated in our department using the supracerebellar approach in the dynamic lateral semisitting position. We used end-tidal carbon dioxide and arterial blood pressure monitoring to detect venous air embolism. RESULTS None of the patients had clinically significant VAE in this study. No tension pneumocephalus or major complications were observed. All the patients were extubated safely after surgery. CONCLUSION The ideal position, with which to apply the supracerebellar approach, is still a challenge. In our study, we presented an alternative position that has advantages of the sitting and semisitting positions with a lower risk of venous air embolism.
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Affiliation(s)
- Yunus Emre Durmuş
- Department of Neurosurgery, Ondokuz Mayis University, School of Medicine, Samsun, Turkey
| | - Barış Kaval
- Department of Neurosurgery, University of Health Sciences, Bakirkoy Prof. Dr. Mazhar Osman Training and Research Hospital for Neurology, Neurosurgery and Psychiatry, Istanbul, Turkey
| | - Bülent Timur Demirgil
- Department of Neurosurgery, University of Health Sciences, Bakirkoy Prof. Dr. Mazhar Osman Training and Research Hospital for Neurology, Neurosurgery and Psychiatry, Istanbul, Turkey
| | - Elif Gökalp
- Department of Neurosurgery, Ankara University, School of Medicine, Ankara, Turkey
| | - Muhammet Enes Gurses
- Department of Neurosurgery, Hacettepe University, School of Medicine, Ankara, Turkey
| | - Eyüp Varol
- Department of Neurosurgery, University of Health Sciences, Umraniye Teaching and Research Hospital, İstanbul, Turkey
| | - Pablo Gonzalez-Lopez
- Department of Neurosurgery, General University Hospital Alicante, Alicante, Spain
| | - Aaron Cohen-Gadol
- Department of Neurosurgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
- The Neurosurgical Atlas, Carmel, Indianapolis, Indiana, USA
| | - Abuzer Gungor
- Department of Neurosurgery, University of Health Sciences, Bakirkoy Prof. Dr. Mazhar Osman Training and Research Hospital for Neurology, Neurosurgery and Psychiatry, Istanbul, Turkey
- Department of Neurosurgery, Microsurgical Neuroanatomy Laboratory, Yeditepe University School of Medicine, Istanbul, Turkey
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Roman A, Tufegdzic B, Lamperti M, Pinto V, Roser F. Before the Knife: A Detailed Step-by-Step Description of an Optimized Semi-Sitting Position in Posterior Fossa Surgery. World Neurosurg 2023; 172:e241-e249. [PMID: 36608791 DOI: 10.1016/j.wneu.2022.12.137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 12/31/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND In an ample armamentarium in neurosurgery, the semi-sitting position has produced debate regarding its benefits and risks. Although the position is apparently intuitive, many have abandoned its use since its initial inception, because of reported complexity and potential complications, leading to impracticality. However, through standardization, it has been shown not only to be safe but to carry with it many advantages, including less risk of secondary neurovascular injuries and better visualization of the surgical field. As with any surgical technical nuance, the semi-sitting position has advantages and disadvantages that must be weighed before the decision is made to adopt it or not, not only in a case-by-case scenario but also from a departmental standpoint. As we attempt to show, the advantages from a standardized approach for the semi-sitting position in experienced institutions may be more than sufficient to significantly outweigh the disadvantages, making it the preferable option for most, although not all, posterior fossa surgical interventions. METHODS In the present study, we aim to elaborate a straightforward narrative of the steps before incision, in an attempt to simplify the complexity of the position, alleviating its disadvantages and exponentially concentrating on its benefits. In nearly 100 steps, we carefully describe the points that culminate with the skin incision, initiating the intraoperative part of the procedure. Each step, therefore, is detailed in full, not in an effort to create a strict manual of the semi-sitting position but rather to facilitate understanding and put the technique into effect in a real-life scenario, thus simplifying what some depict as complex and time consuming. CONCLUSIONS Although several of the steps described are also relevant and integral parts of other surgical positioning, we intend to create a protocol, in a stepwise fashion, to allow facilitated following, to be easily implemented in departments with different levels of experience. The steps comprise nursing care through to electrophysiologic and anesthesiologic approaches, along with neurosurgical cooperation, making it a team approach, not only to avoid position-related complications but also to optimize preoperative standardization, constructing a safe, efficient, and patient-centered scenario, to set the best possible stage for the next step: the intraoperative part of the intervention.
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Affiliation(s)
- Alex Roman
- Neurological Institute, Cleveland Clinic, Abu Dhabi, United Arab Emirates
| | - Boris Tufegdzic
- Anesthesiology Institute, Cleveland Clinic, Abu Dhabi, United Arab Emirates
| | - Massimo Lamperti
- Anesthesiology Institute, Cleveland Clinic, Abu Dhabi, United Arab Emirates
| | - Vania Pinto
- Neurological Institute, Cleveland Clinic, Abu Dhabi, United Arab Emirates
| | - Florian Roser
- Neurological Institute, Cleveland Clinic, Abu Dhabi, United Arab Emirates.
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Vychopen M, Arlt F, Güresir E, Wach J. How to position the patient? A meta-analysis of positioning in vestibular schwannoma surgery via the retrosigmoid approach. Front Oncol 2023; 13:1106819. [PMID: 36816965 PMCID: PMC9929142 DOI: 10.3389/fonc.2023.1106819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 01/16/2023] [Indexed: 02/04/2023] Open
Abstract
Objective Patient positioning is a matter of ongoing debate in the surgical treatment of vestibular schwannoma (VS). Main endpoints of this discussion are preservation of facial nerve functioning, extent of resection, and complications. In this meta-analysis, we aim to investigate the impact of patient positioning on VS surgery via the retrosigmoid approach. Methods We searched for eligible comparative trials on PubMed, Cochrane library, and Web of Science. Positioning groups were compared regarding facial nerve outcome, extent of resection, postoperative hydrocephalus, postoperative CSF leaks, perioperative venous air embolism, and perioperative mortality. Two groups of positions were defined, and the following positions were allocated to those groups: (1) Semi-sitting and Sitting-position; (2) Lateral position, supine position with extensive head rotation, lateral oblique (=Fukushima/Three-quarter prone), and park-bench position. Results From 374 full-text screenings, 7 studies met the criteria and were included in our meta-analysis comprising 1640 patients. Our results demonstrate a significantly better long-term (≥6 months) outcome of the facial nerve after VS surgery in the semi-sitting positioning (OR: 1.49, 95%CI: 1.03-2.15, p = 0.03). Positioning did not influence the extent of resection, rate of postoperative CSF leaks, and the presence of a postoperative hydrocephalus. Overall incidence of venous air embolisms was significantly associated with VS surgery in sitting positioning (OR: 6.77, 95% CI: 3.66-12.54, p < 0.00001). Perioperative mortality was equal among both positioning groups. Conclusion Semi-sitting positioning seems to be associated with an improved facial nerve outcome after VS surgery via the retrosigmoid approach. Venous air embolisms are significantly more often observed among VS patients who underwent surgery in the sitting position, but the perioperative mortality is equal in both positioning groups. Both positioning groups are a safe procedure. Multicentric prospective randomized trials are needed to evaluate the risk-benefit ratio of each positioning in VS surgery via the retrosigmoid approach.
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Wang X, Li M, Xiao X, Chen G, Tang J, Lin Q, Guo H, Song G, Wu X, Bao Y, Liang J. Microsurgery for vestibular schwannoma: analysis of short-term clinical outcome. Chin Neurosurg J 2022; 8:42. [PMID: 36539883 PMCID: PMC9768882 DOI: 10.1186/s41016-022-00306-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 11/10/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Total removal of the vestibular schwannoma when preserving the function of the facial nerve is difficult. The objective of the current study was to investigate the short-term clinical outcome of vestibular schwannoma removal via retro-sigmoid approach. METHODS One-hundred consecutive patients diagnosed with vestibular schwannoma were surgically treated between December 2018 and August 2019 in Xuanwu Hospital, Capital Medical University. The clinical classification, surgical position, gross total removal rate, the anatomical and functional preservation rates of facial nerve, and the postoperative complications were retrospectively analyzed. RESULTS All 100 patients including 34 males and 66 females were operated on via retro-sigmoid approach. According to Koos vestibular schwannoma grading system, 18 cases were grade 2, 34 cases were grade 3, and 48 cases were grade 4. According to Hannover vestibular schwannoma grading system, 5 cases were T2, 6 cases were T3a, 8 cases were T3b, 30 cases were T4a, and 51 cases were T4b. Seventy-three surgeries were performed under lateral position, and 27 cases were operated under semi-sitting position. The gross total removal rate was 90.0%; the anatomic reservation rate of the facial nerve was 96.0%. According to the House-Brackman system, the facial nerve function was grades 1-2 in 78.0% cases, grade 3 in 7.0% cases, and grades 4-5 in 15% cases. For patients with effective hearing before operation, the hearing reservation rate was 19.0%. Two patients (2.0%) developed intracranial hematoma after operation. CONCLUSION Most vestibular schwannoma could be completely removed with good postoperative facial nerve function. If total removal of tumor is difficult, we should give priority to the functional preservation of the nerve function.
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Affiliation(s)
- Xu Wang
- grid.413259.80000 0004 0632 3337Department of Neurosurgery, Xuan Wu Hospital of Capital Medical University, Beijing, China ,China International Neuroscience of Institute (CHINA-INI), Beijing, China
| | - Mingchu Li
- grid.413259.80000 0004 0632 3337Department of Neurosurgery, Xuan Wu Hospital of Capital Medical University, Beijing, China ,China International Neuroscience of Institute (CHINA-INI), Beijing, China
| | - Xinru Xiao
- grid.413259.80000 0004 0632 3337Department of Neurosurgery, Xuan Wu Hospital of Capital Medical University, Beijing, China ,China International Neuroscience of Institute (CHINA-INI), Beijing, China
| | - Ge Chen
- grid.413259.80000 0004 0632 3337Department of Neurosurgery, Xuan Wu Hospital of Capital Medical University, Beijing, China ,China International Neuroscience of Institute (CHINA-INI), Beijing, China
| | - Jie Tang
- grid.413259.80000 0004 0632 3337Department of Neurosurgery, Xuan Wu Hospital of Capital Medical University, Beijing, China ,China International Neuroscience of Institute (CHINA-INI), Beijing, China
| | - Qingtang Lin
- grid.413259.80000 0004 0632 3337Department of Neurosurgery, Xuan Wu Hospital of Capital Medical University, Beijing, China ,China International Neuroscience of Institute (CHINA-INI), Beijing, China
| | - Hongchuan Guo
- grid.413259.80000 0004 0632 3337Department of Neurosurgery, Xuan Wu Hospital of Capital Medical University, Beijing, China ,China International Neuroscience of Institute (CHINA-INI), Beijing, China
| | - Gang Song
- grid.413259.80000 0004 0632 3337Department of Neurosurgery, Xuan Wu Hospital of Capital Medical University, Beijing, China ,China International Neuroscience of Institute (CHINA-INI), Beijing, China
| | - Xiaolong Wu
- grid.413259.80000 0004 0632 3337Department of Neurosurgery, Xuan Wu Hospital of Capital Medical University, Beijing, China ,China International Neuroscience of Institute (CHINA-INI), Beijing, China
| | - Yuhai Bao
- grid.413259.80000 0004 0632 3337Department of Neurosurgery, Xuan Wu Hospital of Capital Medical University, Beijing, China ,China International Neuroscience of Institute (CHINA-INI), Beijing, China
| | - Jiantao Liang
- grid.413259.80000 0004 0632 3337Department of Neurosurgery, Xuan Wu Hospital of Capital Medical University, Beijing, China ,China International Neuroscience of Institute (CHINA-INI), Beijing, China
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Surgical results of 158 petroclival meningiomas with special focus on standard craniotomies. J Neurooncol 2022; 160:55-65. [PMID: 36103000 PMCID: PMC9622548 DOI: 10.1007/s11060-022-04105-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 07/25/2022] [Indexed: 11/06/2022]
Abstract
Objective The goal of this retrospective study is the evaluation of risk factors for postoperative neurological deficits after petroclival meningioma (PCM) surgery with special focus on standard craniotomies. Materials and methods One-hundred-fifty-eight patients were included in the study, of which 133 patients suffered from primary and 25 from recurrent PCM. All patients were operated on and evaluated concerning age, tumor size, histology, pre- and postoperative cranial nerve (CN) deficits, morbidity, mortality, and surgical complications. Tumor-specific features—e.g., consistency, surface, arachnoid cleavage, and location—were set in a four-grade classification system that was used to evaluate the risk of CN deficits and tumor resectability. Results After primary tumor resection, new CN deficits occurred in 27.3% of patients. Preoperative ataxia improved in 25%, whereas 10% developed new ataxia. Gross total resection (GTR) was achieved in 59.4%. The morbidity rate, including hemiparesis, shunt-dependence, postop-hemorrhage, and tracheostomy was 22.6% and the mortality rate was 2.3%. In recurrent PCM surgery, CN deficits occurred in 16%. GTR could be achieved in three cases. Minor complications occurred in 20%. By applying the proposed new classification system to patients operated via standard craniotomies, the best outcome was observed in type I tumor patients (soft tumor consistency, smooth surface, plane arachnoid cleavage, and unilateral localization) with GTR in 78.7% (p < 0.001) and 11.9% new CN deficits (p = 0.006). Conclusion Standard craniotomies as the retrosigmoid or subtemporal/pterional approaches are often used for the resection of PCMs. Whether these approaches are sufficient for GTR—and avoidance of new neurological deficits—depends mainly on the localization and intrinsic tumor-specific features. Supplementary Information The online version contains supplementary material available at 10.1007/s11060-022-04105-5.
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Al-Afif S, Elkayekh H, Omer M, Heissler HE, Scheinichen D, Palmaers T, Nakamura M, Hermann EJ, Samii M, Krauss JK. Analysis of risk factors for venous air embolism in the semisitting position and its impact on outcome in a consecutive series of 740 patients. J Neurosurg 2022; 137:258-265. [PMID: 34740183 DOI: 10.3171/2021.7.jns211107] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 07/01/2021] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Routine use of the semisitting position, which offers several advantages, remains a matter of debate. Venous air embolism (VAE) is a potentially serious complication associated with the semisitting position. In this study, the authors aimed to investigate the safety of the semisitting position by analyzing data over a 20-year period. METHODS The incidence of VAE and its perioperative management were analyzed retrospectively in a consecutive series of 740 patients who underwent surgery between 1996 and 2016. The occurrence of VAE was defined by detection of bubbles on transthoracic Doppler echocardiography (TTDE) or transesophageal echocardiography (TEE) studies, a decrease of end-tidal CO2 (ETCO2) by 4 mm Hg or more, and/or an unexplained drop in systolic arterial blood pressure (≥ 10 mm Hg). From 1996 until 2013 TTDE was used, and from 2013 on TEE was used. The possible risk factors for VAE and its impact on surgical performance were analyzed. RESULTS There were 404 women and 336 men with a mean age at surgery of 49 years (range 1-87 years). Surgery was performed for infratentorial lesions in 709 patients (95.8%), supratentorial lesions in 17 (2.3%), and cervical lesions in 14 (1.9%). The most frequent pathology was vestibular schwannoma. TEE had a higher sensitivity than TTDE. While TEE detected VAE in 40.5% of patients, TTDE had a detection rate of 11.8%. Overall, VAE was detected in 119 patients (16.1%) intraoperatively. In all of these patients, VAE was apparent on TTDE or TEE. Of those, 23 patients also had a decrease of ETCO2, 18 had a drop in blood pressure, and 23 had combined decreases in ETCO2 and blood pressure. VAE was detected in 24% of patients during craniotomy before opening the dura mater, in 67% during tumor resection, and in 9% during wound closure. No risk factors were identified for the occurrence of VAE. Two patients had serious complications due to VAE. Surgical performance in vestibular schwannoma surgery was not affected by the presence of VAE. CONCLUSIONS This study shows that the semisitting position is overall safe and that VAE can be managed effectively. Persistent morbidity is very rare. The authors suggest that the semisitting position should continue to have a place in the standard armamentarium of neurological surgery.
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Affiliation(s)
- Shadi Al-Afif
- 1Department of Neurosurgery, Medical School Hannover, Germany
| | - Hesham Elkayekh
- 1Department of Neurosurgery, Medical School Hannover, Germany
| | - Mazin Omer
- 1Department of Neurosurgery, Medical School Hannover, Germany
| | - Hans E Heissler
- 1Department of Neurosurgery, Medical School Hannover, Germany
| | - Dirk Scheinichen
- 3Department of Anesthesiology and Intensive Care, Medical School Hannover, Germany; and
| | - Thomas Palmaers
- 3Department of Anesthesiology and Intensive Care, Medical School Hannover, Germany; and
| | - Makoto Nakamura
- 2Department of Neurosurgery, University of Witten/Herdecke, Cologne Merheim Medical Center, Cologne, Germany
| | - Elvis J Hermann
- 1Department of Neurosurgery, Medical School Hannover, Germany
| | - Madjid Samii
- 4International Neuroscience Institute, Hannover, Germany
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Arlt F, Kasper J, Winkler D, Jähne K, Fehrenbach MK, Meixensberger J, Sander C. Facial Nerve Function After Microsurgical Resection in Vestibular Schwannoma Under Neurophysiological Monitoring. Front Neurol 2022; 13:850326. [PMID: 35685739 PMCID: PMC9170892 DOI: 10.3389/fneur.2022.850326] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 04/11/2022] [Indexed: 11/30/2022] Open
Abstract
Background The use of intraoperative neurophysiological monitoring, including direct nerve stimulation (especially the facial nerve), acoustic evoked potentials (AEP) and somatosensory evoked potentials (SSEP), is a helpful tool in the microsurgery of vestibular schwannoma to prevent nerve injury. Patient characteristics and intraoperative and postoperative variables might also influence the postoperative facial nerve function. The study was performed to investigate these variables and the intraoperative neurophysiological monitoring values. Methods Seventy-nine patients with vestibular schwannoma were included consecutively into this study. Intraoperative neurophysiological monitoring, including SSEP, AEP, and direct nerve stimulation for facial and trigeminal nerve electromyography, was performed utilizing digital data storage in all cases. The intensity (in volts) of the direct stimulation and the latency (in ms) for the orbicularis oculi and the orbicularis oris muscle and the amplitude (in mV) was measured. Univariate and multivariate statistical analyses concerning the different parameters was performed directly after the operation and in the subsequent follow-ups 3 and 6 months after the operation. Results The mean intensity was 0.79 V (SD.29). The latency and amplitude for the oris muscle was 5.2 ms (SD 2.07) and 0.68 mV (SD.57), respectively. The mean latency for the occuli muscle was 5.58 ms (SD 2.2) and the amplitude was 0.58 mV (SD 1.04). The univariate and multivariate statistical analyses showed significance concerning the postoperative facial nerve function and the amplitude of the direct stimulation of the facial nerve in the orbicularis oris muscle (p = 0.03), so repeated direct nerve stimulation might show FN function deterioration. The mean diameter of the tumors was 24 mm (range 10–57 mm). Cross total resection and near total was achieved in 76 patients (96%) and subtotal in three patients (4%). The preoperative House–Brakeman score (HBS) 1 was constant in 65 (82%) cases. The mortality in our series was 0%; the overall morbidity was 10%. The HBS was not influenced concerning the extent of resection. The mean follow-up was 28 months (range 6 to 60 months). The limitations of the study might be a low number of patients and the retrospective character of the study. Conclusion Intraoperative neurophysiological monitoring is crucial in vestibular schwannoma surgery. Repeated direct nerve stimulation and a detected decreased amplitude might show facial nerve function deterioration.
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Song G, Liu D, Wu X, Wang X, Zhou Y, Li M, Lin Q, Guo H, Tang J, Xiao X, Chen G, Bao Y, Liang J. Outcomes after semisitting and lateral positioning in large vestibular schwannoma surgery: A single-center comparison. Clin Neurol Neurosurg 2021; 207:106768. [PMID: 34175644 DOI: 10.1016/j.clineuro.2021.106768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 06/16/2021] [Accepted: 06/17/2021] [Indexed: 12/01/2022]
Abstract
OBJECTIVE The semisitting position (SSP) and lateral position (LP) in vestibular schwannoma (VS) surgery each have advantages and disadvantages, and which position is superior overall is debatable. Our objective was to determine the optimal position for surgical treatment of VSs with a diameter ≥3 cm. METHODS We retrospectively evaluated consecutive patients with a large VS treated between January 2010 and July 2020. Patients were grouped by surgical position and analyzed. RESULTS We enrolled 259 patients (LP group, n = 156; SSP group, n = 103). The resection extent was not significantly different between the SSP (gross-total resection [GTR], n = 89 [88.1%], near-total resection [NTR], n = 10 [9.9%], subtotal resection [STR], n = 2 [2.0%]) and LP (GTR, n = 125 [80.1%]; NTR, n = 24 [15.4%]; STR, n = 7 [4.5%]) groups. The rate of GTR with facial nerve (FN) functional preservation was higher in the SSP group than in the LP group (P = 0.014) at eight days after the operation. However, during follow-up (SSP group median, 31.5 months; LP group median, 19.5 months), there was no significant between-group difference in FN functional preservation. Two patients in the SSP group required conversion to the LP due to severe intraoperative venous air embolism (VAE). CONCLUSION Compared with the LP, the SSP did not produce significantly better FN outcomes in patients with a large VS. The duration of surgery was significantly longer in SSP cases than in LP cases. Given the risk of VAE associated with the SSP, the selection of the optimal surgical position should be made with caution on an individual basis.
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Affiliation(s)
- Gang Song
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, 45 Changchun St, Xicheng District, Beijing, China
| | - Dong Liu
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, 45 Changchun St, Xicheng District, Beijing, China
| | - Xiaolong Wu
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, 45 Changchun St, Xicheng District, Beijing, China
| | - Xu Wang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, 45 Changchun St, Xicheng District, Beijing, China
| | - Yiqiang Zhou
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, 45 Changchun St, Xicheng District, Beijing, China
| | - Mingchu Li
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, 45 Changchun St, Xicheng District, Beijing, China
| | - Qingtang Lin
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, 45 Changchun St, Xicheng District, Beijing, China
| | - Hongchuan Guo
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, 45 Changchun St, Xicheng District, Beijing, China
| | - Jie Tang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, 45 Changchun St, Xicheng District, Beijing, China
| | - Xinru Xiao
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, 45 Changchun St, Xicheng District, Beijing, China
| | - Ge Chen
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, 45 Changchun St, Xicheng District, Beijing, China
| | - Yuhai Bao
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, 45 Changchun St, Xicheng District, Beijing, China
| | - Jiantao Liang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, 45 Changchun St, Xicheng District, Beijing, China.
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