POSTOPERATIVE RADIOGRAPHIC FINDINGS FOLLOWING ACOUSTIC NEUROMA REMOVAL

This paper assesses the radiographic findings seen on early postoperat ive CT following acoustic neuroma resection. CT head scans were routin ely obtained from 86 patients within 24 hours of tumor resection via a translabyrinthine or retrosigmoid approach. Repeat CT scans were perf ormed in those patients with abnormal clinical symptoms. The abnormali ties seen on postoperative CT included cerebellar hematoma (nine patie nts), cerebral and/or cerebellar infarction (six patients), CSF leak a t the incision (two patients), subdural hematoma (two patients), hydro cephalus (one patient), and residual acoustic neuroma (two patients). An unexpected CT finding was ipsilateral temporal lobe lucency, sugges ting venous edema, ischemia, and/or infarction in 16% (14/86) of patie nts. Overall, the clinical complication rate was 8%, and subclinical C T abnormalities were seen in 17% of patients. Temporal lobe venous ede ma, ischemia, or infarction is a complication of translabyrinthine res ection of acoustic neuroma, and is thought to be due to obstruction of an inferior temporal lobe draining vein. Some cases may be related to intraoperative interruption of the superior petrosal sinus or petrosa l vein, and/or coagulation of the sigmoid sinus dural margins: interru ption of an inferior temporal vein, or venous hypotension. Care in dea ling with the superior petrosal and sigmoid Sinuses at surgery is need ed.