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Neurosurgery. 2013 Jun;72(2 Suppl Operative):ons103-15; discussion ons115. doi: 10.1227/NEU.0b013e3182752b05.

Contemporary surgical management of vestibular schwannomas: analysis of complications and lessons learned over the past decade.

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  • 1Division of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA. yoichi.nonaka@gmail.com

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%.

CONCLUSION:

Many of these complications are avoidable through further refinement of operative technique, and strategies for avoiding complications are proposed.

PMID:
23037828
[PubMed - indexed for MEDLINE]
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