Microsurgical resection of vestibular schwannomas: complication avoidance

J Neurooncol. 2016 Nov;130(2):367-375. doi: 10.1007/s11060-016-2260-4. Epub 2016 Sep 20.


Vestibular schwannoma (VS) surgery requires appropriate patient selection, meticulous microsurgical technique and optimal post-operative care. Focused radiation is an effective alternative for the treatment of smaller VSs. For VS surgery to remain a reasonable option, surgery must be performed with a limited number of complications. Complication rates for VS surgery have increased over the last decade. This is likely due to (1) decreased surgical volume and as a result decreased microsurgical experience, (2) larger tumors undergoing surgery while smaller tumors are reserved for radiation, and (3) surgery for previously radiated tumors resulting in more difficult anatomic dissection. Appropriate management of complications is paramount. Herein, we discuss complications related to VS microsurgery and methods of avoidance. Specifically, we discuss the most frequently encountered complications, intraoperative monitoring and finally, methods of addressing these complications. With meticulous microsurgical technique, careful intraoperative monitoring and vigilant perioperative care one will ensure optimal patient outcomes.

Keywords: Cerebrospinal fluid; Facial nerve palsy; Headache; Hearing preservation; Leak; Vestibular schwannoma.

Publication types

  • Review

MeSH terms

  • Cerebrospinal Fluid Leak / etiology
  • Cerebrospinal Fluid Leak / prevention & control
  • Cerebrovascular Disorders / etiology
  • Cerebrovascular Disorders / prevention & control
  • Cranial Nerve Injuries / etiology
  • Cranial Nerve Injuries / prevention & control
  • Headache / etiology
  • Headache / prevention & control
  • Humans
  • Hydrocephalus / etiology
  • Hydrocephalus / prevention & control
  • Intraoperative Complications*
  • Meningitis / etiology
  • Meningitis / prevention & control
  • Microsurgery / adverse effects*
  • Monitoring, Intraoperative
  • Neuroma, Acoustic / complications*
  • Neuroma, Acoustic / surgery*
  • Neurosurgical Procedures / adverse effects*
  • Postoperative Complications*
  • Sinus Thrombosis, Intracranial / etiology
  • Sinus Thrombosis, Intracranial / prevention & control