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[Vascular complications after acoustic neurinoma surgery]
1Service d'ORL et Chirurgie Cervico-Faciale, Hôpital Lariboisière, 2, rue Ambroise Paré, 75475, Paris, France.
Objective:
To report six cases of vascular complications occurring after acoustic neuroma surgery and to discuss the postoperative signs and symptoms that should alert the surgeon, in order to undertake the appropriate treatment as soon as possible.
Methods:
Four hundred thirty-two cases of acoustic tumors operated by the same surgeons between January 1991 and December 2000 were reviewed.
Results:
Six cases of vascular complications were identified: one case of cerebral vasospasm secondary to persistence of subarachnoid blood after injury to Dandy's vein; three cases of arterial infarction giving rise to a partial anterior inferior cerebellar artery (AICA) syndrome with an unusual nystagmus in two cases (ipsilateral in one patient and strong controlateral in one patient presenting preoperative vestibular areflexia); one case of hematoma of the cerebello-pontine angle (CPA) causing strong ipsilateral nystagmus; and one case of venous infarction of the cerebellar vermis secondary to accidental sinus thrombosis.
Conclusions:
Vascular complications after acoustic neuroma surgery are potentially devastating and should be identified as early as possible. Rapid extubation is recommended for systematic neurologic assessment. Among abnormal signs and symptoms that should alert the surgeon, marked nystagmus ipsilateral to the operated side or contralateral in patient presenting preoperative vestibular areflexia appears to be of great value.