Reconstructive options for skull defects following translabyrinthine surgery for vestibular schwannomas.
OBJECTIVE
Advances in microsurgical techniques have dramatically decreased the major complications of translabyrinthine vestibular schwannoma surgery. Recent trends in the reconstruction of the skull defect following this type of surgery have focused on addressing two postoperative morbidities: cerebrospinal fluid leak and postauricular deformity. Various reconstructive paradigms have shown an improvement in both areas over traditional techniques. Options for addressing these problems continue to evolve as surgeons strive to improve patient satisfaction. This review highlights such reconstructive options and their respective challenges.


RESULTS
Current techniques include the use of various materials such as hydroxyapatite, titanium and vascularized cortical bone flap. Hydroxyapatite and titanium mesh alloplastic reconstruction are associated with improved outcome but increased surgical cost. Vascularized cranioplasty bone flap appears to achieve the same endpoint with no added cost.


CONCLUSIONS
Cranioplasty following translabyrinthine vestibular schwannoma excision has evolved in an effort to reduce postoperative cerebrospinal fluid leaks and cosmetic deformities. Long-term results and cost-benefit analysis are needed to determine the efficacy and general application of these techniques.
Yuen
Heng-Wai
HW
Department of Otolaryngology-Head & Neck Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
Chen
Joseph M
JM
D000273:Adipose Tissue / Q000637:transplantation; D016025:Bone Transplantation / Q000379:methods; D003399:Craniotomy / Q000379:methods*; D007758:Ear, Inner / Q000601:surgery*; D006801:Humans; D006882:Hydroxyapatites / Q000627:therapeutic use; D008416:Mastoid / Q000601:surgery; D008866:Microsurgery / Q000379:methods; D009464:Neuroma, Acoustic / Q000175:diagnosis / Q000601:surgery*; D019736:Prostheses and Implants; D019651:Plastic Surgery Procedures / Q000379:methods*; D013524:Surgical Flaps / Q000098:blood supply; D013526:Surgical Mesh; D020858:Tissue and Organ Harvesting / Q000379:methods; D014025:Titanium
D006882:Hydroxyapatites; C475044:hydroxyapatite cement; D014025:Titanium