J Neurol Surg B Skull Base 2014; 75 - a179
DOI: 10.1055/s-0034-1384082

Complications and Their Preventions of Large Intracranial Vestibular Schwannoma via Retrosigmoid Approach: A Retrospective Review of 1,167 Cases

Xiang Huang 1, Jian Xu 1, Ping Zhong 1, Ying Mao 1
  • 1Huashan Hospital, Shanghai, Peoples Republic of China

Objective: To discuss the common complications from the microsurgical treatment of large intracranial vestibular schwannoma via retrosigmoid approach. Study Design: Clinical status and complications were assessed postoperatively with 14 days and at the time of follow-up. Patients and Methods: Surgical outcomes and complications were evaluated in a consecutive series of 1,167 unilateral vestibular schwannomas treated in Shanghai Huashan Hospital from 1999 to 2013. Results: Total tumor resections were achieved in 1,006 patients (86.2%). The facial nerve was preserved anatomically in 1,083 cases (92.8%) after operation, and the functional valuation of facial nerve according to postoperative House-Brackmann show 423 patients (36.2%) in grade I-II, 534 cases (45.8%) in grade III, and 210 patients (18.0%) in grade IV-VI. The main short-term postoperative complication included disequilibrium in 250 cases (21.4%), intracranial infection in 115 (9.85%), lower cranial nerve deficit in 77 cases (6.59%). Follow-up data were available for 978 of the 1,167 patients (83.8%). Long-term postoperative complications include loss of hearing and permanent facial paralysis. Conclusions: Many of these complications are avoidable. To master the clinical anatomy of the approach, using intraoperative nerve monitoring and preoperatively study the clinical data were the keys to avoid these complications.