Hemorrhagic Risk in Vestibular Schwannoma Surgeries: Insights and Implications.

in Medical science monitor : international medical journal of experimental and clinical research by Alper Tabanli, Hakan Yilmaz, Emrah Akçay, Hüseyin Berk Benek, Ibrahim Burak Atci, Mesut Mete

TLDR

  • The study found that larger vestibular schwannoma size is associated with increased hemorrhagic nature, complicating total resection, and that subtotal resection increases the risk of postoperative bleeding and edema.

Abstract

BACKGROUND Vestibular schwannoma is a slow-growing benign tumor arising from the 8th cranial nerve. It can originate in the cerebellopontine angle (CPA). This retrospective study aimed to investigate the factors associated with outcomes following surgical resection of vestibular schwannoma in the CPA in 30 patients at a single center in Turkey, focusing on postoperative intratumoral hemorrhage. MATERIAL AND METHODS Thirty patients (mean age 42.8 years, range 17-81) underwent vestibular schwannoma surgery via a lateral suboccipital retrosigmoid approach. Patients were categorized as 'less bleeding' (n=15) or 'more bleeding' (n=15) based on the intraoperative nature of the tumor. Demographic characteristics, tumor size, extent of resection, postoperative intratumor bleeding rates, morbidity, and mortality were evaluated. RESULTS Mean tumor size was significantly larger in highly hemorrhagic tumors (3.8 cm, range 2.1-5 cm) compared with less hemorrhagic tumors (2.1 cm, range 1.8-3 cm) (P<0.001). Total resection was achieved in 60% of patients with highly hemorrhagic tumors >3 cm and chronic diseases, compared with 80% in less hemorrhagic tumors (P=0.02). Postoperative intratumoral hemorrhage occurred in 83.3% of subtotal resections in highly hemorrhagic tumors, versus 6.7% in less hemorrhagic tumors (P<0.001). CONCLUSIONS Larger vestibular schwannoma size is associated with increased hemorrhagic nature, complicating total resection. Subtotal resection in hemorrhagic tumors significantly increases the risk of postoperative bleeding and edema. When possible, total removal should be attempted to minimize complications. In cases requiring subtotal excision, careful postoperative management of coagulation and blood pressure is crucial.

Overview

  • The study aimed to investigate factors associated with outcomes following surgical resection of vestibular schwannoma in the CPA, focusing on postoperative intratumoral hemorrhage.
  • Thirty patients underwent surgery via a lateral suboccipital retrosigmoid approach, with patients categorized as 'less bleeding' or 'more bleeding' based on intraoperative tumor characteristics.
  • The primary objective was to identify factors influencing postoperative bleeding rates and overall outcomes, with a focus on the relationship between tumor size and hemorrhagic nature.

Comparative Analysis & Findings

  • Larger tumor size was significantly associated with a higher likelihood of hemorrhagic nature (P<0.001).
  • Total resection was achieved in 60% of patients with highly hemorrhagic tumors (>3 cm) and chronic diseases, compared to 80% in less hemorrhagic tumors (P=0.02).
  • Postoperative intratumoral hemorrhage occurred in 83.3% of subtotal resections in highly hemorrhagic tumors, versus 6.7% in less hemorrhagic tumors (P<0.001).

Implications and Future Directions

  • The study highlights the importance of considering tumor size and hemorrhagic nature when planning surgical resection of vestibular schwannomas.
  • Future studies should investigate the impact of hemorrhagic tumor characteristics on outcomes in other anatomical locations.
  • Careful postoperative management of coagulation and blood pressure is crucial when subtotal excision is necessary, to minimize complications and risks.
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