title: Risk factors for vagal palsy following cerebellopontine angle surgery.
abstract: OBJECTIVE
  Describe the incidence, risk factors, and outcomes of postoperative vagal palsy in patients undergoing surgical excision of cerebellopontine angle (CPA) tumors.
  
  
  METHODS
  Case series with chart review.
  
  
  METHODS
  Academic tertiary care center.
  
  
  METHODS
  One hundred eighty-one consecutive patients undergoing surgical excision of CPA pathology from January 1, 2008, to December 31, 2010, at Johns Hopkins Hospital. Postoperative unilateral vagal palsy was identified by laryngoscopy or videofluoroscopy, and clinical variables were collected from medical records.
  
  
  RESULTS
  Postoperative unilateral vagal palsy was identified in 19 of 181 (10%) patients. Vocal fold motion impairment (VFMI) in combination with pharyngeal palsy was more common than VFMI or pharyngeal palsy alone. Those with vagal palsy had a larger mean tumor size (30 mm) than those without vagal palsy (20 mm, P = .0002) and a significantly longer mean hospital stay (9 vs 5 days, P < .0001). Vagal palsy was not associated with tumor pathology, prior treatment (stereotactic radiation or prior surgery), or surgical approach (suboccipital craniotomy vs translabyrinthine approach). Significant rates of aspiration were observed in patients with vagal palsy (67%).
  
  
  CONCLUSIONS
  Voice and swallowing function can be affected by surgical excision of pathology of the CPA. Tumor size is an independent risk factor for postoperative vagal palsy, which in turn has important consequences for prolonged hospital stay, aspiration, and voice and swallowing impairment.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medical Institution, Baltimore, Maryland 21287, USA.
authors.forename: Simon R
authors.initials: SR
authors.lastname: Best
authors.forename: Heather M
authors.initials: HM
authors.lastname: Starmer
authors.forename: Yuri
authors.initials: Y
authors.lastname: Agrawal
authors.forename: Bryan K
authors.initials: BK
authors.lastname: Ward
authors.forename: Alexander T
authors.initials: AT
authors.lastname: Hillel
authors.forename: Wade W
authors.initials: WW
authors.lastname: Chien
authors.forename: Howard W
authors.initials: HW
authors.lastname: Francis
authors.forename: Rafael J
authors.initials: RJ
authors.lastname: Tamargo
authors.forename: Lee M
authors.initials: LM
authors.lastname: Akst
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002530:Cerebellopontine Angle / Q000601:surgery*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects*; D012189:Retrospective Studies; D012307:Risk Factors; D014826:Vocal Cord Paralysis / Q000453:epidemiology / Q000209:etiology*; D055815:Young Adult