Safety and Facial Nerve Outcomes of Intracisternal Papaverine Irrigation for Vestibular Schwannoma Resection

Papaverine, a vasodilator approved for use by the U.S. Food and Drug Administration, has shown efficacy in treating vasospasm in cardiology, urology, and nephrology. The vasodilatory effect of papaverine is also hoped to protect the facial nerve from ischemic damage and nerve manipulation during ves...

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Bibliographic Details
Published in:World neurosurgery 2022-12, Vol.168, p.e490-e499
Main Authors: Silva, Michael A., Chang, Henry, Shah, Ashish H., Khan, Nickalus R., Brown, Clifford S., Dinh, Christine T., Eshraghi, Adrien A., Telischi, Fred F., Angeli, Simon I., Morcos, Jacques J.
Format: Article
Language:English
Subjects:
Acoustic neuroma
Facial nerve
Facial Nerve - surgery
Facial Nerve Injuries - etiology
Humans
Neuroma, Acoustic - complications
Neuroma, Acoustic - surgery
Neuromonitoring
Neurooncology
Papaverine
Postoperative Complications - epidemiology
Postoperative Complications - etiology
Retrospective Studies
Tumor
Vestibular schwannoma
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Summary:Papaverine, a vasodilator approved for use by the U.S. Food and Drug Administration, has shown efficacy in treating vasospasm in cardiology, urology, and nephrology. The vasodilatory effect of papaverine is also hoped to protect the facial nerve from ischemic damage and nerve manipulation during vestibular schwannoma surgery. Our institution uses intracisternal papaverine irrigation during vestibular schwannoma resection to protect the facial nerve in patients with neuromonitoring changes. Our objective was to investigate the safety and facial nerve outcomes of intracisternal papaverine irrigation during vestibular schwannoma resection. We retrospectively reviewed patients who underwent resection of vestibular schwannoma at our institution between 2008 and 2021. Patients received papaverine if the intraoperative facial nerve stimulation threshold increased above 0.05 mA. Postoperative outcomes were compared with control patients who did not receive papaverine. A total of 283 cases were included in our analysis. Patients who received papaverine (n = 60) had lower immediate postoperative House-Brackmann (HB) grades than did control individuals (mean, 1.54 vs. 1.95; P = 0.029) and a lower likelihood of immediate postoperative HB grade >1 (odds ratio, 0.514; P = 0.039). At long-term follow-up, there was no significant difference in HB grade. Papaverine use was not associated with increased rates of perioperative complications (P = 0.24). The off-label use of intracisternal papaverine irrigation during vestibular schwannoma resection can certainly be used safely for select cases. It is associated with improved immediate postoperative facial nerve outcomes, similar long-term facial nerve outcomes, and no significant increase in complications.
ISSN:1878-8750
1878-8769
DOI:10.1016/j.wneu.2022.10.017