Polymethylmethacrylate Versus Autologous Bone Flap Reconstruction After Retrosigmoid Vestibular Schwannoma Surgery: Impact on Wound Healing and Patient Satisfaction.

Abstract

Retrosigmoid repair techniques vary widely between and within institutions, complicating comparisons of patient satisfaction and complications. This study aimed to analyze patients' satisfaction with the skin flap healing process and associated symptoms, such as pain, hypoesthesia, dysesthesia, pressure, and tension, as well as to assess wound healing complications, and to evaluate both clinical and esthetic results using polymethylmethacrylate (PMMA) or autologous bone coverage following vestibular schwannoma surgery. A retrospective analysis was conducted in 157 consecutive patients (median age 54 years, interquartile range 40-62, 91 female) who underwent retrosigmoid vestibular schwannoma resection between 2019 and 2023. Clinical factors related to wound healing and skull defect coverage complications were assessed in 110 of 157 patients. PMMA was used in 94 patients (60%) and autologous bone in 63 (40%). Complications that needed an in-hospital treatment occurred in 7 of 157 (4%) patients, including 1 wound infection and four subgaleal cerebrospinal fluid collections. Wound healing disorders were significantly more common in patients with autologous bone (19% vs. 4%, P = 0.02). Using PMMA was independently associated with lower chances of wound healing disorders in a multivariate logistic regression (odds ratio 0.20, 95% confidence interval 0.04-0.87, P = 0.032). No significant differences were found between the two groups in terms of retroauricular pain, dysesthesia, hypoesthesia, pressure, tension, swelling, headache, esthetic appearance, or overall satisfaction. While patient satisfaction did not differ between reconstruction methods, PMMA for bone defect coverage in vestibular schwannoma surgery may have the potential to reduce wound healing disorders compared with autologous bone.