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Clinical Trial
. 2014:2014:315952.
doi: 10.1155/2014/315952. Epub 2014 May 28.

Complications of microsurgery of vestibular schwannoma

Jan Betka  1 , Eduard Zvěřina  1 , Zuzana Balogová  2 , Oliver Profant  2 , Jiří Skřivan  1 , Josef Kraus  3 , Jiří Lisý  4 , Josef Syka  5 , Martin Chovanec  1
Affiliations
Clinical Trial

Complications of microsurgery of vestibular schwannoma

Jan Betka et al. Biomed Res Int. 2014.

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.

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Figures

Figure 1
Figure 1
Lateral variant of CSF leak/pseudomeningocele (T2W MRI). Arrowhead: pseudomeningocele, arrow demonstrates CSF filled pneumatic system of the temporal bone.
Figure 2
Figure 2
Medial variant of CSF leak. (a) T2W MRI, arrowhead pointing to the fistula; arrow demonstrates CSF filled pneumatic system of temporal bone. (b) Wound revision with identification of fistula in the posterior rim of meatotomy; asterisk shows the closed IAC. (c) Endoscopic view of the fistula.
Figure 3
Figure 3
CT scan of patient with intracerebellar haematoma.
Figure 4
Figure 4
CT scan of patient with haematoma of the cerebellopontine angle.
Figure 5
Figure 5
MRI of patient with the supratentorial ischemia as a consequence of microembolisation (paradox embolisation excluded).
Figure 6
Figure 6
MRI of patient with peduncular venous infarction (asterisk) due to superior petrous vein injury.
See this image and copyright information in PMC

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