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01-12-2024 | Vestibular Schwannoma | Review

Temporal lobe injury with middle fossa approach to intracanalicular vestibular schwannomas: a systematic review

Authors: Gabriel Flores-Milan, Gersham J. Rainone, Keaton Piper, Ivo Peto, Christopher Danner, Kyle P. Allen, Shih Sing Liu, Harry van Loveren, Siviero Agazzi

Published in: Neurosurgical Review | Issue 1/2024

Abstract

There are several surgical approaches for vestibular schwannoma (VS) resection. However, management has gradually shifted from microsurgical resection, toward surveillance and radiosurgery. One of the arguments against microsurgery via the middle fossa approach (MFA) is the risk of temporal lobe retraction injury or sequelae. Here, we sought to evaluate the incidence of temporal lobe retraction injury or sequela from a MFA via a systematic review of the existing literature. This systematic review was conducted according to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. Relevant studies reporting temporal lobe injury or sequela during MFA for VS were identified. Data was aggregated and subsequently analyzed to evaluate the incidence of temporal lobe injury. 22 studies were included for statistical analysis, encompassing 1522 patients that underwent VS resection via MFA. The overall rate of temporal lobe sequelae from this approach was 0.7%. The rate of CSF leak was 5.9%. The rate of wound infection was 0.6%. Meningitis occurred in 1.6% of patients. With the MFA, 92% of patients had good facial outcomes, and 54.9% had hearing preservation. Our series and literature review support that temporal lobe retraction injury or sequelae is an infrequent complication from an MFA for intracanalicular VS resection.

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Title: Temporal lobe injury with middle fossa approach to intracanalicular vestibular schwannomas: a systematic review
Authors: Gabriel Flores-Milan
Gersham J. Rainone
Keaton Piper
Ivo Peto
Christopher Danner
Kyle P. Allen
Shih Sing Liu
Harry van Loveren
Siviero Agazzi
Publication date: 01-12-2024
Publisher: Springer Berlin Heidelberg
Keywords: Vestibular Schwannoma
Vestibular Schwannoma
Published in: Neurosurgical Review / Issue 1/2024
Print ISSN: 0344-5607
Electronic ISSN: 1437-2320
DOI: https://doi.org/10.1007/s10143-024-02425-w

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Temporal lobe injury with middle fossa approach to intracanalicular vestibular schwannomas: a systematic review

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