title: Microsurgical resection of vestibular schwannomas: complication avoidance.
abstract: Vestibular schwannoma (VS) surgery requires appropriate patient selection, meticulous microsurgical technique and optimal post-operative care. Focused radiation is an effective alternative for the treatment of smaller VSs. For VS surgery to remain a reasonable option, surgery must be performed with a limited number of complications. Complication rates for VS surgery have increased over the last decade. This is likely due to (1) decreased surgical volume and as a result decreased microsurgical experience, (2) larger tumors undergoing surgery while smaller tumors are reserved for radiation, and (3) surgery for previously radiated tumors resulting in more difficult anatomic dissection. Appropriate management of complications is paramount. Herein, we discuss complications related to VS microsurgery and methods of avoidance. Specifically, we discuss the most frequently encountered complications, intraoperative monitoring and finally, methods of addressing these complications. With meticulous microsurgical technique, careful intraoperative monitoring and vigilant perioperative care one will ensure optimal patient outcomes.
authors.affiliation: Department of Neurosurgery, Duke University Medical Center, 1000 Trent Drive 4520 Hosp South, Box 3807, Durham, NC, 27710, USA. Shervin.rahimpour@duke.edu.
authors.forename: Shervin
authors.identifier: 0000-0003-2718-181X
authors.initials: S
authors.lastname: Rahimpour
authors.affiliation: Department of Neurosurgery, Duke University Medical Center, 1000 Trent Drive 4520 Hosp South, Box 3807, Durham, NC, 27710, USA.
authors.forename: Allan H
authors.initials: AH
authors.lastname: Friedman
authors.affiliation: Department of Neurosurgery, Duke University Medical Center, 1000 Trent Drive 4520 Hosp South, Box 3807, Durham, NC, 27710, USA.|Carolina Neuroscience Institute, 4030 Wake Forest Rd suite 115, Raleigh, NC, 27612, USA.
authors.forename: Takanori
authors.initials: T
authors.lastname: Fukushima
authors.affiliation: Department of Neurosurgery, Duke University Medical Center, 1000 Trent Drive 4520 Hosp South, Box 3807, Durham, NC, 27710, USA.
authors.forename: Ali R
authors.initials: AR
authors.lastname: Zomorodi
mesh_terms: D065634:Cerebrospinal Fluid Leak / Q000209:etiology / Q000517:prevention & control; D002561:Cerebrovascular Disorders / Q000209:etiology / Q000517:prevention & control; D020209:Cranial Nerve Injuries / Q000209:etiology / Q000517:prevention & control; D006261:Headache / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D006849:Hydrocephalus / Q000209:etiology / Q000517:prevention & control; D007431:Intraoperative Complications; D008581:Meningitis / Q000209:etiology / Q000517:prevention & control; D008866:Microsurgery / Q000009:adverse effects*; D016343:Monitoring, Intraoperative; D009464:Neuroma, Acoustic / Q000150:complications* / Q000601:surgery*; D019635:Neurosurgical Procedures / Q000009:adverse effects*; D011183:Postoperative Complications; D012851:Sinus Thrombosis, Intracranial / Q000209:etiology / Q000517:prevention & control
keywords: Cerebrospinal fluid; Facial nerve palsy; Headache; Hearing preservation; Leak; Vestibular schwannoma