Introduction: Post-operative infection is an important cause of morbidity in patients undergoing surgery for vestibular schwannoma. We sought to determine what patient characteristics and surgical factors were associated with post-operative infection.
Methods: We conducted a retrospective analysis of 130 patients who underwent a translabyrinthine or retrosigmoid approach for vestibular schwannoma at Vanderbilt University Medical Center from January 2004 to April 2013, collecting data on patient characteristics and perioperative variables. Infection was defined as evidence of meningitis or wound infection. Cerebrospinal fluid leak was defined as wound leakage, rhinorrhea, or pseudomeningocele. The chi-square test and simple logistic regression were used for analysis with significance set at 0.05.
Results: There was no significant relationship between infection and age greater than 50 years, sex, hypertension, coronary artery disease, chronic obstructive pulmonary disease, or diabetes (Table 1). Additionally, the modifiable risk factors of obesity and smoking were not significantly associated with the odds of infection post-operatively. Perioperative factors including approach, procedure length, and length of stay were also not significantly associated with infection. The presence of cerebrospinal fluid leak was significantly associated with infection (p<0.001).
Conclusions: None of the patient comorbidities we measured were significantly associated with the odds of infection. This is important for counseling regarding surgical treatment of vestibular schwannoma as several common comorbid conditions were not significantly associated with post-operative infection. Interestingly, length of stay and procedure length were not associated with increased odds of infection in our series. Cerebrospinal fluid leak is highly associated with infection, indicating the importance of proper surgical technique and closure.
Patient Care: By analyzing the relationship between patient characteristics and post-operative risk of infection, we will be better able to counsel patients regarding risks and benefits of surgery for vestibular schwannoma on an individual basis.
Learning Objectives: By the conclusion of this session, participants should be able to describe the association between patient characteristics and post-operative infection in vestibular schwannoma surgery.
References: • Bryce GE, Nedzelski JM, Rowed DW, Rappaport JM. Cerebrospinal fluid leaks and meningitis in acoustic neuroma surgery. Otolaryngol Head Neck Surg. 1991 Jan;104(1):81-7.
• Legnani FG, Saladino A, Casali C, Vetrano IG, Varisco M, Mattei L, Prada F, Perin A, Mangraviti A, Solero CL, Dimeco F. Craniotomy vs. craniectomy for posterior fossa tumors: a prospective study to evaluate complications after surgery. Acta Neurochir (Wien). 2013 Sep 29. [Epub ahead of print]
• Becker SS, Jackler RK, Pitts LH. Cerebrospinal fluid leak after acoustic neuroma surgery: a comparison of the translabyrinthine, middle fossa, and retrosigmoid approaches. Otol Neurotol. 2003 Jan;24(1):107-12.
• Selesnick SH, Liu JC, Jen A, Newman J. The incidence of cerebrospinal fluid leak after vestibular schwannoma surgery. Otol Neurotol. 2004 May;25(3):387-93.
• Rodgers GK, Luxford WM. Factors affecting the development of cerebrospinal fluid leak and meningitis after translabyrinthine acoustic tumor surgery. Laryngoscope. 1993 Sep;103(9):959-62.
• Samii M, Matthies C. Management of 1000 vestibular schwannomas (acoustic neuromas): surgical management and results with an emphasis on complications and how to avoid them. Neurosurgery. 1997 Jan;40(1):11-21; discussion 21-3.
• Gormley WB, Sekhar LN, Wright DC, Kamerer D, Schessel D. Acoustic neuromas: results of current surgical management. Neurosurgery. 1997 Jul;41(1):50-8; discussion 58-60.
• Cueva RA, Mastrodimos B. Approach design and closure techniques to minimize cerebrospinal fluid leak after cerebellopontine angle tumor surgery. Otol Neurotol. 2005 Nov;26(6):1176-81.
• Brennan JW, Rowed DW, Nedzelski JM, Chen JM. Cerebrospinal fluid leak after acoustic neuroma surgery: influence of tumor size and surgical approach onincidence and response to treatment. J Neurosurg. 2001 Feb;94(2):217-23.
• Fishman AJ, Hoffman RA, Roland JT Jr, Lebowitz RA, Cohen NL. Cerebrospinal fluid drainage in the management of CSF leak following acoustic neuroma surgery. Laryngoscope. 1996 Aug;106(8):1002-4.
• Chamoun R, MacDonald J, Shelton C, Couldwell WT. Surgical approaches for resection of vestibular schwannomas: translabyrinthine, retrosigmoid, and middle fossaapproaches. Neurosurg Focus. 2012 Sep;33(3):E9. doi: 10.3171/2012.6.FOCUS12190.
• Sanna M, Taibah A, Russo A, Falcioni M, Agarwal M. Perioperative complications in acoustic neuroma (vestibular schwannoma) surgery. Otol Neurotol. 2004 May;25(3):379-86.
• Slattery WH 3rd, Francis S, House KC. Perioperative morbidity of acoustic neuroma surgery. Otol Neurotol. 2001 Nov;22(6):895-902.
• Fayad JN, Schwartz MS, Slattery WH, Brackmann DE. Prevention and treatment of cerebrospinal fluid leak after translabyrinthine acoustic tumor removal. Otol Neurotol. 2007 Apr;28(3):387-90.
• Merkus P, Taibah A, Sequino G, Sanna M. Less than 1% cerebrospinal fluid leakage in 1,803 translabyrinthine vestibular schwannoma surgery cases. Otol Neurotol. 2010 Feb;31(2):276-83.
• Roche PH, Pellet W, Moriyama T, Thomassin JM. Translabyrinthine approach for vestibular schwannomas: operative technique. Prog Neurol Surg. 2008;21:73-8.
• Yashar P, Zada G, Harris B, Giannotta SL. Extent of resection and early postoperative outcomes following removal of cystic vestibular schwannomas: surgical experience over a decade and review of the literature. Neurosurg Focus. 2012 Sep;33(3):E13.