Reconstructive options for skull defects following translabyrinthine surgery for vestibular schwannomas.

Evidence from laboratory and animal studies provides groundwork for understanding mechanisms and potential before human studies continue.

• Level A · Stronger Clinical Evidence
• Level B · Emerging clinical evidence with positive signals
• Level C · Early human research exploring benefits
• Level D · Scientific groundwork from lab and animal studies
• Emerging · Emerging topic under active research

Abstract (original English)

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. 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. 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.

Evidence level

Evidence from laboratory and animal studies provides groundwork for understanding mechanisms and potential before human studies continue.

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