Contemporary surgical management of vestibular schwannomas: Analysis of complications and lessons learned over the past decade

Yoichi Nonaka, Takanori Fukushima, Kentaro Watanabe, Allan H. Friedman, John H. Sampson, John T. McElveen, Calhoun D. Cunningham, Ali R. Zomorodi

Research output: Contribution to journalArticlepeer-review

79 Scopus citations

Abstract

BACKGROUND:: Despite advanced microsurgical techniques, more refined instrumentation, and expert team management, there is still a significant incidence of complications in vestibular schwannoma surgery. OBJECTIVE:: To analyze complications from the microsurgical treatment of vestibular schwannoma by an expert surgical team and to propose strategies for minimizing such complications. METHODS:: Surgical outcomes and complications were evaluated in a consecutive series of 410 unilateral vestibular schwannomas treated from 2000 to 2009. Clinical status and complications were assessed postoperatively (within 7 days) and at the time of follow-up (range, 1-116 months; mean, 32.7 months). RESULTS:: Follow-up data were available for 357 of the 410 patients (87.1%). Microsurgical tumor resection was performed through a retrosigmoid approach in 70.7% of cases. Thirty-three patients (8%) had intrameatal tumors and 204 (49.8%) had tumors that were <20 mm. Gross total resection was performed in 306 patients (74.6%). Hearing preservation surgery was attempted in 170 patients with tumors <20 mm, and good hearing was preserved in 74.1%. The main neurological complication was facial palsy (House-Brackmann grade III-VI), observed in 14% of patients (56 cases) postoperatively; however, 59% of them improved during the follow-up period. Other neurological complications were disequilibrium in 6.3%, facial numbness in 2.2%, and lower cranial nerve deficit in 0.5%. Nonneurological complications included cerebrospinal fluid leaks in 7.6%, wound infection in 2.2%, and meningitis in 1.7%. CONCLUSION:: Many of these complications are avoidable through further refinement of operative technique, and strategies for avoiding complications are proposed. ABBREVIATIONS:: ABR, auditory brainstem responseAICA, anterior inferior cerebellar arteryCN, cranial nerveCPA, cerebellopontine angleFN, facial nerveGTR, gloss total resectionH-B, House-BrackmannHPS, hearing preservation surgeryNTR, near-total resectionSRT, stereotactic radiation therapySTR, subtotal resectionVAFE, vascular, adherent, fibrous, and engulfingVS, vestibular schwannoma.

Original languageEnglish
Pages (from-to)ons103-ons115
JournalNeurosurgery
Volume72
DOIs
StatePublished - Jun 2013
Externally publishedYes

Keywords

  • Acoustic neuroma
  • Facial nerve palsy
  • Hearing preservation
  • Postoperative complications
  • Vestibular schwannoma

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