title: Retrosigmoid Versus Translabyrinthine Approach for Acoustic Neuroma Resection: An Assessment of Complications and Payments in a Longitudinal Administrative Database.
abstract: Object Retrosigmoid (RS) and translabyrinthine (TL) surgery remain essential treatment approaches for symptomatic or enlarging acoustic neuromas (ANs). We compared nationwide complication rates and payments, independent of tumor characteristics, for these two strategies. Methods We identified 346 and 130 patients who underwent RS and TL approaches, respectively, for AN resection in the 2010-2012 MarketScan database, which characterizes primarily privately-insured patients from multiple institutions nationwide. Results Although we found no difference in 30-day general neurological or neurosurgical complication rates, in TL procedures there was a decreased risk for postoperative cranial nerve (CN) VII injury (20.2% vs 10.0%, CI 0.23-0.82), dysphagia (10.4% vs 3.1%, CI 0.10-0.78), and dysrhythmia (8.4% vs 2.3%, CI 0.08-0.86). Overall, there was no difference in surgical repair rates of CSF leak; however, intraoperative fat grafting was significantly higher in TL approaches (19.8% vs 60.2%, CI 3.95-9.43). In patients receiving grafts, there was a trend towards a higher repair rate after RS approach, while in those without grafts, there was a trend towards a higher repair rate after TL approach. Median total payments were $16,856 higher after RS approaches ($67,774 vs $50,918, p < 0.0001), without differences in physician or 90-day postoperative payments. Conclusions  Using a nationwide longitudinal database, we observed that the TL, compared to RS, approach for AN resection experienced lower risks of CN VII injury, dysphagia, and dysrhythmia. There was no significant difference in CSF leak repair rates. The payments for RS procedures exceed payments for TL procedures by approximately $17,000. Data from additional years and non-private sources will further clarify these trends.
authors.affiliation: Medical Student, Stanford University School of Medicine.
authors.forename: Tyler
authors.initials: T
authors.lastname: Cole
authors.affiliation: Department of Neurosurgery, Stanford University School of Medicine.
authors.forename: Anand
authors.initials: A
authors.lastname: Veeravagu
authors.affiliation: Department of Neurosurgery, Stanford University School of Medicine.
authors.forename: Michael
authors.initials: M
authors.lastname: Zhang
authors.affiliation: Department of Neurosurgery, Stanford University School of Medicine.
authors.forename: Tej
authors.initials: T
authors.lastname: Azad
authors.affiliation: Department of Neurosurgery, Stanford University School of Medicine.
authors.forename: Christian
authors.initials: C
authors.lastname: Swinney
authors.affiliation: Department of Neurosurgery, Stanford University School of Medicine.
authors.forename: Gordon H
authors.initials: GH
authors.lastname: Li
authors.affiliation: Department of Neurosurgery, Stanford University School of Medicine.
authors.forename: John K
authors.initials: JK
authors.lastname: Ratliff
authors.affiliation: Department of Neurological Surgery, Keck School of Medicine of USC.
authors.forename: Steven L
authors.initials: SL
authors.lastname: Giannotta
keywords: acoustic neuroma; csf leak; fat grafting; payments; retrosigmoid; translabyrinthine