Perioperative complications in acoustic neuroma (vestibular schwannoma) surgery.
OBJECTIVE
Retrospective study and review of the complications other than those related to the facial nerve and hearing, encountered in acoustic neuroma surgery. Also, an evaluation of hospital stay and its relation with various factors.


METHODS
Retrospective case review.


METHODS
Tertiary neurotologic and skull base referral center.


METHODS
A series of 707 patients who underwent surgical removal of acoustic neuroma from April 1987 to December 2001.


METHODS
The surgical approaches used were the enlarged translabyrinthine approach, the enlarged middle fossa approach, and the retrosigmoid approach. In a small number of cases, the operations were performed through other approaches.


METHODS
The duration of hospital stay and appearance of complications in the perioperative period along with their management. Results related to the facial nerve and hearing were not considered in this study.


RESULTS
The most frequent complication was abdominal subcutaneous hematoma (site of fat harvest), which occurred in 23 patients (3.2%). Cerebrospinal fluid leak was present in 20 patients (2.8%), 15 of whom needed revision surgery. Other complications included VIth cranial nerve dysfunction in 12 cases (1.68%), subdural hematoma in 3 cases (0.4%), cerebellopontine angle hematoma in 4 cases (0.6%), cerebellar edema in 2 cases (0.28%), brainstem hematoma in 1 case (0.14%), transitory aphasia in 1 case (0.14%), and lower cranial nerve dysfunction in 1 case (0.14%). Mortality occurred in only one case (0.14%). Medical complications seldom occurred. The postoperative hospital stay ranged from 2 to 36 days, with an average of 6.4 days. The overall hospital stay diminished over time from 10.2 days in 1987 to 1990, to 4.9 days in 2001. There was a significant relation between hospital stay and tumor size, approach used, and presence/absence of complications.


CONCLUSIONS
Perioperative complications in acoustic neuroma surgery do exist, but this study demonstrated how low the incidence is. The authors believe that the low percentage of complications is mainly attributable to the majority of operations being carried out in specialized clinics, where they are considered routine operations. They believe that following individualized approaches, depending on tumor size and on the preoperative function of the cranial nerves, is the proper way to reach a significant reduction in complications while maintaining a high percentage of total tumor removal. The results of this study, considered as a basis of comparison with other studies, will certainly be useful in preoperative patient counseling.
Sanna
Mario
M
Gruppo Otologico, Piacenza, Rome, Italy. mario.sanna@gruppootologico.it
Taibah
Abdelkader
A
Russo
Alessandra
A
Falcioni
Maurizio
M
Agarwal
Manoj
M
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002558:Cerebrospinal Fluid Otorrhea / Q000453:epidemiology / Q000209:etiology; D003389:Cranial Nerve Diseases / Q000453:epidemiology / Q000209:etiology; D007758:Ear, Inner / Q000601:surgery*; D005260:Female; D006406:Hematoma / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D015994:Incidence; D020300:Intracranial Hemorrhages / Q000453:epidemiology / Q000209:etiology; D007431:Intraoperative Complications / Q000453:epidemiology / Q000209:etiology*; D007902:Length of Stay; D008297:Male; D008581:Meningitis / Q000453:epidemiology / Q000209:etiology; D008875:Middle Aged; D009464:Neuroma, Acoustic / Q000601:surgery*; D013506:Otologic Surgical Procedures / Q000009:adverse effects* / Q000401:mortality; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D012189:Retrospective Studies; D016896:Treatment Outcome