title: Surgery for sporadic vestibular schwannoma. Part II. Complications (not related to facial and auditory nerves).
abstract: BACKGROUND
  The aim of this study was to analyze the frequency and consequences of postoperative complications (PC) after surgery for sporadic vestibular schwannoma and to find factors that increase the risk of PC occurrence.
  
  
  METHODS
  The study included 220 consecutive patients (134 women, 86 men; age ranged from 18 to 74) operated on with the retrosigmoid (217) or translabyrinthine (3) approach. Complicated postoperative period was defined as an occurrence of at least one of: cerebrospinal fluid (CSF) leakage, hematoma in the tumor bed, intracerebellar hematoma, cerebellar swelling, brainstem stroke, hydrocephalus (HCP), healing problems, meningitis and cranial nerves (excluding VII-VIII) palsies or cerebellar symptoms. Correlation studies and multivariate regression analysis were performed.
  
  
  RESULTS
  PC occurred in 55 patients (25%). PC included lower cranial nerve (LCN) palsy (8.2%), cerebellar symptoms (7.3%), CSF leakage (5.9%), HCP (5%), CNVI palsy (3.1%), meningitis (1.8%), cerebellar swelling (1.4%), CNV dysfunction (0.9%), intracerebellar hematoma (0.5%) and lethal brainstem stroke (0.5%). In long term follow-up, LCN deficit was present in 2 patients (0.9%), cerebellar syndrome in 4(1.8%) and facial hypoesthesia in 2(0.9%). One patient (0.5%) developed bilateral blindness, secondary to preoperative optic nerve atrophy. As a result of PC, 10 patients (4.5%) required 11 additional surgical procedures. In statistical analysis, PC were independently related to preoperative cerebellar syndrome (p=0.002) and tumor size (>30 mm vs.<30 mm, p<0.05). The risk of PC diminished significantly with the increased number of performed procedures from 40% at the beginning to 16.4% in the last 55 cases.
  
  
  CONCLUSIONS
  Tumor size, cerebellar syndrome at presentation and experience of the team were the three most important risk factors for PC occurrence. Permanent deficit secondary to PC remained in only 4% of the patients.
authors.affiliation: Department of Neurosurgery, Medical University of Warsaw, Warszawa, Poland.
authors.forename: Przemysław
authors.initials: P
authors.lastname: Kunert
authors.affiliation: Department of Neurosurgery, Medical University of Warsaw, Warszawa, Poland. Electronic address: tomasz_dziedzic@wp.pl.
authors.forename: Tomasz
authors.initials: T
authors.lastname: Dziedzic
authors.affiliation: Department of Neurosurgery, Medical University of Warsaw, Warszawa, Poland.
authors.forename: Tomasz
authors.initials: T
authors.lastname: Czernicki
authors.affiliation: Department of Neurosurgery, Medical University of Warsaw, Warszawa, Poland.
authors.forename: Arkadiusz
authors.initials: A
authors.lastname: Nowak
authors.affiliation: Department of Neurosurgery, Medical University of Warsaw, Warszawa, Poland.
authors.forename: Andrzej
authors.initials: A
authors.lastname: Marchel
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009464:Neuroma, Acoustic / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*; D019635:Neurosurgical Procedures / Q000009:adverse effects* / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000453:epidemiology; D012307:Risk Factors; D055815:Young Adult
keywords: Cerebrospinal fluid leakage; Neurosurgery; Postoperative complications; Retrosigmoid approach; Vestibular schwannoma