Introduction: Despite the rapid development of microsurgical techniques, and more refined instrumentation, the incidence of complications in vestibular schwannoma surgery was still significant. Here we want to report the clinical experience on vestibular schwannoma surgery in the past 15 years in Department of Neurosurgery, Huashan Hospital, which is the largest center for neurosurgery clinical service and research in rising China, and to discuss the common complications from the microsurgical treatment of large intracranial vestibular schwannoma via suboccipital retrosigmoid approach and to propose strategies for minimizing such complications.
Methods: Surgical outcomes and complications were evaluated in a consecutive series of 1167 unilateral vestibular schwannomas treated in Shanghai Huashan Hospital from 1999 to 2013.
Results: Total tumor resection was achieved in 1006 patients (86.2%), subtotal resection in 159 patients (13.6%), and partial resection in 2 patients (0.171%). The facial nerve was preserved anatomically in 1083 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, 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 cases (9.85 %), lower cranial nerve deficit in 77 cases (6.59 %) and hearing loss in 228 cases (19.5%). Follow-up data were available for 978 of the 1167 patients (83.8%). Long-term postoperative complications include loss of hearing (45.9%) and permanent facial paralysis (6.77%).
Conclusions: Many of these complications are avoidable. To master the clinical anatomy of the approach, using intraoperative nerve monitoring and preoperative analysis of individual imaging and clinical data were the keys to avoid these complications.
Patient Care: In our research, the clinical experience of these 1167 cases was shared and the strategies were discussed for reducing the mortality and morbidity in vestibular schwannoma surgery. It was found in our analysis that surgical experiences, using intraoperative nerve monitoring, and preoperative analysis of individual imaging and clinical data was key to avoid the complications of large intracranial vestibular schwannoma via suboccipital retrosigmoid approach and to improve patients’ quality of life after surgery.
Learning Objectives: To discuss the common complications from the microsurgical treatment of large intracranial vestibular schwannoma via suboccipital retrosigmoid approach and to propose strategies for minimizing such complications.