title: Beyond audiofacial morbidity after vestibular schwannoma surgery.
abstract: OBJECTIVE
  Outcomes following vestibular schwannoma (VS) surgery have been extensively described; however, complication rates reported in the literature vary markedly. In addition, the majority of reports have focused on outcomes related to cranial nerves (CNs) VII and VIII. The objective of this study was to analyze reported morbidity unrelated to CNs VII and VIII following the resection of VS.
  
  
  METHODS
  The authors performed a comprehensive search of the English language literature, identifying and aggregating morbidity and death data from patients who had undergone microsurgical removal of VSs. A subgroup analysis based on surgical approach and tumor size was performed to compare rates of CSF leakage, vascular injury, neurological deficit, and postoperative infection.
  
  
  RESULTS
  One hundred articles met the inclusion criteria, providing data for 32,870 patients. The overall mortality rate was 0.2% (95% CI 0.1-0.3%). Twenty-two percent of patients (95% CI 21-23%) experienced at least 1 surgically attributable complication unrelated to CNs VII or VIII. Cerebrospinal fluid leakage occurred in 8.5% of patients (95% CI 6.9-10.0%). This rate was markedly increased with the translabyrinthine approach but was not affected by tumor size. Vascular complications, such as ischemic injury or hemorrhage, occurred in 1% of patients (95% CI 0.75-1.2%). Neurological complications occurred in 8.6% of cases (95% CI 7.9-9.3%) and were less likely with the resection of smaller tumors (p < 0.0001) and the use of the translabyrinthine approach (p < 0.0001). Infections occurred in 3.8% of cases (95% CI 3.4-4.3%), and 78% of these infections were meningitis.
  
  
  CONCLUSIONS
  This study provides statistically powerful data for practitioners to advise patients about the published risks of surgery for VS unrelated to compromised CNs VII and VIII.
authors: Department of Neurological SurgeryUniversity of California at San Francisco, 94143, USA.
authors: Michael E
authors: ME
authors: Sughrue
authors: Isaac
authors: I
authors: Yang
authors: Derick
authors: D
authors: Aranda
authors: Martin J
authors: MJ
authors: Rutkowski
authors: Shanna
authors: S
authors: Fang
authors: Steven W
authors: SW
authors: Cheung
authors: Andrew T
authors: AT
authors: Parsa
mesh_terms: D002558:Cerebrospinal Fluid Otorrhea / Q000209:etiology; D002559:Cerebrospinal Fluid Rhinorrhea / Q000209:etiology; D016009:Chi-Square Distribution; D006801:Humans; D008581:Meningitis / Q000209:etiology; D009464:Neuroma, Acoustic / Q000601:surgery*; D019635:Neurosurgical Procedures / Q000009:adverse effects*; D011183:Postoperative Complications / Q000209:etiology; D016896:Treatment Outcome