Complications of Surgery for Sporadic Vestibular Schwannoma

Abstract

Objectives. We sought to investigate the postoperative complications of vestibular schwannoma excision and determine their significant clinical predictors.Study Design. Cross-sectional. Setting. California Hospital Inpatient Discharge Datasets 1997-2011.Subjects and Methods. Data for vestibular schwannoma excisions performed in California were extracted using the ICD-9-CM code ''04.01 excision of acoustic neuroma. '' Demographics, principal payer, state of residence, comorbidities, as well as hospital case volume were examined as possible predictors. Postoperative complications and patient disposition were examined as outcome variables. Comorbidities and complications were identified using ICD-9-CM diagnoses and procedures codes.Results. Overall, 6553 cases were examined. Comorbidities were present in 2539 (38.7%) patients. Postoperative complications occurred in 1846 (28.2%) patients; 1714 (26.2%) neurological and 337 (5.1%) medical complications. Patients' admission ended with death or further care (ie, skilled nursing facilities) in 260 (4.0%) cases. Mortality rate was 0.2%. No significant changes were observed over time. Multivariate analysis revealed that the odds of neurological complications were greater in the 2007-2011 period (OR = 1.51; 95% CI, 1.12-2.04), in patients with comorbidities (OR = 1.48; 95% CI, 1.16-1.88), and in hospitals with low case volume (OR = 1.69; 95% CI. 1.31-2.18). The odds of medical complications were also greater in the 2007-2011 period (OR = 1.69; 95%, CI 1.02-2.80). Female gender, non-Caucasian ethnicity, presence of comorbidities, and low hospital case volume were associated with greater odds of patients requiring further care.Conclusion. Comorbidities and low hospital case volume were major risk factors for complications. No significant changes in rates of complications from vestibular schwannoma surgery were observed over the 15-year period.

Tratamiento del neurinoma acústico gigante

“…Mahboubi et al 42 estudiaron las complicaciones quirúrgi-cas ocurridas en 6.553 casos de schwannomas vestibulares de todos los tamaños operados en California entre 1997 y 2011. Estos autores identificaron complicaciones significativas en el 28,2% de los pacientes, y resultado de muerte o graves secuelas en 260 pacientes (4%), con una mortalidad operatoria del 0,2%.…”

“…Estos autores identificaron complicaciones significativas en el 28,2% de los pacientes, y resultado de muerte o graves secuelas en 260 pacientes (4%), con una mortalidad operatoria del 0,2%. En el citado estudio se identificaron 2 factores de riesgo principales para la ocurrencia de complicaciones y muerte: las comorbilidades y el hecho de ser operado en un centro con bajo número de casos 42 .…”

Nonsteroidal anti-inflammatory medications are cytostatic against human vestibular schwannomas

“…Both of these procedures can result in serious complications. Surgical resection entails full or partial removal of the tumor via craniotomy and carries substantial risks, including sensorineural hearing loss, vestibular dysfunction, facial nerve paralysis, cerebrospinal fluid leaks and meningitis (3, 4). Stereotactic radiotherapy entails delivering a radiation dose to the tumor and can be associated with severe side effects such as further exacerbation of the sensorineural hearing loss, vestibular dysfunction and potential malignant transformation of the tumor (5, 6).…”

Preoperative Lumbar Drain Use During Acoustic Neuroma Surgery and Effect on CSF Leak Incidence

“…Cerebrospinal fluid leaks after AN microsurgery typically present with otorrhea, headache, and dizziness and can lead to grave sequellae such as meningitis and brain abscess formation. 1 Meticulous surgical technique and tight wound closure are cornerstones for CSF leak prevention, but no formal guidelines exist for the routine use of preoperative lumbar drain placement to lower the incidence of CSF leaks following AN microsurgery.…”