Symptomatic subdural hygroma and temporal lobe edema after translabyrinthine removal of acoustic neuroma

The translabyrinthine approach is familiar to most neurosurgeons and neuro- otologists and is frequently used to remove acoustic neuromas. Some of the complications associated with this surgery include cerebrospinal fluid (CSF ) leaks, meningitis, and rarely fat graft prolapse. The authors report a 60 -year-old woman who underwent a translabyrinthine approach and microsurgica l resection of a right-sided l-cm acoustic neuroma. Initially, she was disc harged home after an uneventful postoperative course. Four days later, she sought treatment in the emergency room complaining of headaches, dizziness, and lethargy. A computed tomographic (CT) scan showed a large right-sided subdural hygroma and right temporal lobe edema. The patient underwent burr hole evacuation of the collection and placement of a subdural drain, after which the edema in the temporal lobe and hygroma resolved. We speculate tha t the underlying mechanism was the result of inadvertant damage to the veno us drainage and an arachnoid tear that was not appreciated during surgery. Neurosurgeons and neuro-otogists should be aware of this unusual complicati on of translabyrinthine surgery and its possible underlying mechanisms.