Complications and their managements of large intracranial vestibular schwannoma via retrosigmoid approach.

Complications and their managements of large intracranial vestibular schwannoma via retrosigmoid approach.

World Neurosurg. 2016 Dec 22;:

Authors: Huang X, Xu M, Xu J, Zhou L, Zhong P, Chen M, Ji K, Chen H, Mao Y

Abstract
OBJECTIVE: To investigate the common complications from the microsurgical treatment of large intracranial vestibular schwannoma (VS) via suboccipital retrosigmoid approach and to propose strategies for minimizing such complications.
METHODS: We selected all large unilateral VS patients from the collected database (1999-2013) who underwent microsurgical resection as their initial treatment for histopathologically confirmed VS. Tumors larger than 30 x 20 mm were defined as large.
RESULTS: A total of 1167 VS patients were included. Gross total tumor resection was achieved in 1006 patients (86.2%). The mortality rate is 0.77%. The facial nerve was preserved anatomically in 1083 cases (92.8%), and the functional valuation of the facial nerve according to postoperative House-Brackmann scale showed 423 patients (36.2%) in grades I-II, 534 cases (45.8%) in grade III, 210 patients (18.0%) in grade IV-VI. The main short-term postoperative complication included new hearing loss (AAO-HNS grade D) in 634 cases (54.3%), disequilibrium in 250 cases (21.4%), labial herpes in 127 cases (10.9%), meningitis in 115 (9.85%) and lower cranial nerve deficit in 77 cases (6.59%). Follow-up data were available for 978 of the 1167 patients (83.8%). Long-term complications include hearing loss (AAO-HNS grade D) (75.8%), permanent facial paralysis (11.9%), facial numbness (10.9%), tinnitus (2.96%), chronic headache (2.25%) and taste disturbance (1.43%).
CONCLUSIONS: The key factors for reducing surgical complications include careful assessment of the functions of acoustic and facial nerves as well as a thorough understanding of anatomy via the retrosigmoid approach before operation, skillful microsurgical technique, and monitoring of multiple cranial nerves during resection.

PMID: 28017747 [PubMed - as supplied by publisher]

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