小脳橋角腫瘍手術における術中脳槽開頭術：術後脳脊髄液シャントを行わない単一施設での経験

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.

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.

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.

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.