Complications of acoustic tumor surgery.

In removing acoustic tumors, the primary goal is total removal, with preservation of life and the least possible permanent neurological sequelae. In all but the smallest of cerebellopontine angle lesions, total tumor removal necessitates sacrifice of the eighth cranial nerve. In large lesions, total tumor removal may necessitate sacrifice of the seventh cranial nerve as well. The optimal approaches for accomplishing these goals with minimal complications are the translabyrinthine and combined translabyrinthine-suboccipital approaches. The middle fossa approach is appropriate only for intracanalicular lesions. In the series of 383 tumor cases discussed, total tumor removal was accomplished in 379 (99 per cent) of the cases. Overall, the facial nerve was preserved in 80 per cent of the patients. There were no fatalities. The most frequent complication was postoperative cerebrospinal fluid leakage. Surgery of the posterior fossa continues to be hazardous, with significant morbidity rates. Complications do occur, and those performing these procedures must be prepared to manage them. The occurrence of complications can be greatly reduced through a thorough preoperative evaluation as well as through meticulous microsurgical attention to detail. It is important for all surgeons working in the cerebellopontine angle to reassess their technique periodically in order to improve results. In our experience, self-re-evaluation has reduced postoperative complications, particularly in regard to cerebrospinal fluid leaks. Early diagnosis of acoustic neuromas would permit surgery for smaller lesions, thereby decreasing complications. However, it is well recognized that we will continue to see a high percentage of large tumors and must be prepared to handle these difficult lesions and their complications.