Complications of Microsurgery of Vestibular Schwannoma

Abstract

Background. The aim of this study was to analyze complications of vestibular schwannoma (VS) microsurgery. Material and Methods. A retrospective study was performed in 333 patients with unilateral vestibular schwannoma indicated for surgical treatment between January 1997 and December 2012. Postoperative complications were assessed immediately after VS surgery as well as during outpatient followup. Results. In all 333 patients microsurgical vestibular schwannoma (Koos grade 1: 12, grade 2: 34, grade 3: 62, and grade 4: 225) removal was performed. The main neurological complication was facial nerve dysfunction. The intermediate and poor function (HB III–VI) was observed in 124 cases (45%) immediately after surgery and in 104 cases (33%) on the last followup. We encountered disordered vestibular compensation in 13%, permanent trigeminal nerve dysfunction in 1%, and transient lower cranial nerves (IX–XI) deficit in 6%. Nonneurological complications included CSF leakage in 63% (lateral/medial variant: 99/1%), headache in 9%, and intracerebral hemorrhage in 5%. We did not encounter any case of meningitis. Conclusions. Our study demonstrates that despite the benefits of advanced high-tech equipment, refined microsurgical instruments, and highly developed neuroimaging technologies, there are still various and significant complications associated with vestibular schwannomas microsurgery.

Complications of the Middle Cranial Fossa Approach for Acoustic Neuroma Removal

“…Minovi et al [18] also reported on one case (1.1%) of lethal PE after DVT in a series of 89 AN patients operated on via MFA. There is a comparable rate of PE in further series with mixed approaches of 0.2%-1.1% [14,[19][20][21][25][26][27] .…”

“…Despite this low number, intracranial bleedings are the most common cause of death after AN surgery as reported for all approaches and all tumor sizes [5,14,19] . These bleedings are often caused by direct damage to vessels in the field of surgery.…”

An Unusual Variant of Cerebellopontine Angle Schwannoma in a Young Nepalese Girl

“…Mortality and morbidity have been reduced grossly in the recent years. CSF leakage, meningitis, postoperative headache, intraoperative vascular accidents, cranial nerve injuries are the main complications [14]. Availability of ultrasonic aspirators, shavers, and fiber lasers make the total excision more promising in reducing the morbidity.…”

“…However, sophisticated tools are still lacking in developing couturiers due to limited resources. Most of the complications are the consequences of the inadequate surgical maneuvers ascertaining the vital structures complicated by the tumor [14]. Meticulous surgical excision and postoperative care are always mandatory for gross total removal without complications (Figure 1).…”

Outcomes in Patients with Vestibular Schwannoma after Subtotal Resection and Adjuvant Radiosurgery

“…In fact, 3 patients reported a slight improvement in symptoms specifically related to vestibular dysfunction. Similarly, trigeminal neuropathy often goes unreported in the literature [32,34,35], with V2 and V3 representing the most frequently affected braches. In our study 4 patients (17.39%) developed postoperative facial numbness, with a resolution of symptoms occurring in all but 1 within the 1-month follow-up.…”