Analysis of Morbidity and Mortality in Vestibular Schwannoma Resections 2012–2016

Introduction: We analyzed perioperative risk factors for morbidity and mortality for the patients undergoing surgical intervention for vestibular schwannoma along with rates of reoperations and cerebrospinal fluid leaks that required surgery.

Materials and Methods: Patients undergoing surgery vestibular schwannoma were identified in the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database from 2012 to 2016 using CPT codes for posterior fossa surgical approaches and ICD9 and ICD10 codes for peripheral nerve sheath tumor. Preoperative laboratories, comorbidities, and operative times were analyzed along with cerebrospinal fluid leaks and unplanned returns to the operating room.

Results: A total of 993 patients who underwent surgery for vestibular schwannoma were identified. Average age was 51, 41% were male, and 58% were female. Mortality within 30 days of the operation was very low at 0.4%, nonneurological complications were 7% with infection being the most common at 2.3%, and unplanned reoperations happened in 7.4% of the cases. Dependent functional status and operative time over 6 hours were the only significant predictors of perioperative complications (p < 0.01). CSF leak postoperatively occurred in 31 patients (3.1%). Reoperation in those with CSF leak was necessary in 58% of the cases. Interestingly patients undergoing translabyrinthine approach by itself or in addition to the craniotomy were more likely to develop a CSF leak (OR: 2.1, 95% CI: 1.01–4.3, p = 0.05).

Conclusion: Duration of surgery over 6 hours and dependent functional status preoperatively are the greatest predictors of complications in the 30-day postoperative period.

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