Vestibular schwannoma surgery outcomes: our multidisciplinary experience in 400 cases over 17 years.
OBJECTIVE
The aim of the study was to evaluate the incidence of short- and intermediate-term postoperative complications after vestibular schwannoma surgery.


METHODS
Retrospective review in a tertiary referral center.


METHODS
In 400 patients who underwent surgical removal of vestibular schwannoma from 1984 to 2000,symptoms, preoperative evaluation, surgery, and postoperative complications were analyzed using standardized grading systems.


RESULTS
One hundred ninety-four men and 206 women had an operation. Mean age was 53.9 years (age range, 11-78 y). Tumor size according to Koos stage was stage 1 in 39 cases, stage 2 in 122 cases, stage 3 in 87 cases, and stage 4 in 152 cases. Preoperatively, 7.5% of patients had facial nerve dysfunction. Surgical approaches were translabyrinthine in 229 patients, widened retrolabyrinthine in 128 cases, suboccipital in 42 cases, and transotic in 1 case. Mortality was 0.5%. Facial nerve was transected in 15 cases (3.7%) and immediately repaired in 5 cases. A delayed hypoglossal-to-facial nerve anastomosis was performed in 12 cases. At 1 year, House-Brackmann grade in 70.7% of patients was 1 to 2; in 24.3%, 3 to 4; and in 5%, 5 to 6. Poor facial nerve outcome was correlated with tumor size, preoperative irradiation, and nerve dysfunction and was not correlated with the approach used. Most patients had postoperative dizziness, and 30% still had vestibular disturbances after 1 year. Nine patients (2.2%) had a cerebrospinal fluid rhinorrhea, and 24 had a cerebrospinal fluid wound leak (6%). Twenty-two patients (5.5%) had postoperative meningitis. Two patients had a cerebellopontine angle hemorrhage, and three a brainstem infarct.


CONCLUSIONS
Transpetrosal approaches (translabyrinthine, widened retrolabyrinthine) are safe for vestibular schwannoma removal, and rates of postoperative complications and sequelae are decreasing.
Darrouzet
Vincent
V
Department of Skull Base Surgery, University Hospital of Bordeaux, Bordeaux, France. vincent.darrouzet@chu-bordeax.fr
Martel
Jacques
J
Enée
Véronique
V
Bébéar
Jean-Pierre
JP
Guérin
Jean
J
D000293:Adolescent; D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use; D002558:Cerebrospinal Fluid Otorrhea / Q000453:epidemiology / Q000209:etiology; D002648:Child; D005158:Facial Paralysis / Q000453:epidemiology / Q000209:etiology; D005260:Female; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D009464:Neuroma, Acoustic / Q000601:surgery*; D013506:Otologic Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D017063:Outcome Assessment, Health Care; D010348:Patient Care Team; D011183:Postoperative Complications / Q000453:epidemiology; D011655:Pulmonary Embolism / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology; D012189:Retrospective Studies; D014717:Vertigo / Q000453:epidemiology / Q000209:etiology; D014945:Wound Healing
D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight