Abstract
OBJECTIVE
The translabyrinthine approach to the posterior fossa was pioneered by House in the 1960s, and has since gained increasing popularity amongst Neurotologists. The surgical defect is typically repaired with a free adipose tissue graft. The long-term viability of such grafts is good, but resorption can occur, with potential for complications. We describe a subacute presentation of a tension pneumocele 23 years after translabyrinthine resection of a large vestibular schwannoma.
METHOD
Case report. Setting: Tertiary care, academic medical center.
RESULTS
A 64 year-old woman with a 2 week history of rapidly progressive ataxia and right-sided headache, 23 years after right, translabyrinthine resection of a 4 cm vestibular schwannoma. A large, bilobed, mastoid-posterior fossa tension pneumocele was seen on CT, and treated with urgent surgical decompression, dural repair and mastoid reobliteration with free abdominal adipose graft. The symptoms were immediately relieved post-operatively, and repeat imaging confirmed resolution of the pneumocele.
CONCLUSION
Ultra-delayed complications of translabyrinthine surgery have not been described. With the passing of time since popularization of this approach, more such uncommon complications may be seen. Neurotologists should be aware of the possibility of their occurrence and approaches to treatment.