title: Contemporary surgical management of vestibular schwannomas: analysis of complications and lessons learned over the past decade.
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%.
  
  
  CONCLUSIONS
  Many of these complications are avoidable through further refinement of operative technique, and strategies for avoiding complications are proposed.
authors.affiliation: Division of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA. yoichi.nonaka@gmail.com
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Nonaka
authors.forename: Takanori
authors.initials: T
authors.lastname: Fukushima
authors.forename: Kentaro
authors.initials: K
authors.lastname: Watanabe
authors.forename: Allan H
authors.initials: AH
authors.lastname: Friedman
authors.forename: John H
authors.initials: JH
authors.lastname: Sampson
authors.forename: John T
authors.initials: JT
authors.lastname: Mcelveen
authors.forename: Calhoun D
authors.initials: CD
authors.lastname: Cunningham
authors.forename: Ali R
authors.initials: AR
authors.lastname: Zomorodi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009464:Neuroma, Acoustic / Q000601:surgery*; D019635:Neurosurgical Procedures / Q000009:adverse effects* / Q000379:methods; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D055815:Young Adult