Complications of the translabyrinthine approach for the removal of acoustic neuromas.

OBJECTIVE To report the complications that occurred during a large series of surgical procedures for the removal of acoustic neuromas using the translabyrinthine approach. DESIGN Retrospective analysis. SETTING Neuro-otology practice with academic affiliation. Procedures were performed at either a university medical center or a community hospital in conjunction with a neurosurgery team. PATIENTS A total of 258 patients (142 men, 116 women; mean age, 51 years) underwent the translabyrinthine approach during a 14-year period. All patients had a histologically proven diagnosis of acoustic neuroma. RESULTS There were no deaths. There were 3 cases (1.1%) of neurovascular compromise. There were 20 cases (7.8%) of cerebrospinal fluid leak, 16 (80%) of which presented as rhinorrhea and 4 (20%) as incisional leaks. The leaks at the incision responded to conservative management, while rhinorrhea usually required more aggressive means of closure. Four patients (1.6%) were diagnosed as having bacterial meningitis. Complete gross tumor removal was not achieved in 4 patients (1.6%). Facial nerve function, as measured by the House-Brackmann system, was recorded in all patients at 1 year: 76% had a score of I or II; 18%, a score of III or IV; and 6%, a score of V or VI. Other complications included 3 cases of pneumonia, 1 case of severe gastric hemorrhage, and 1 case of wound infection. CONCLUSIONS The results of this series generally agree with those of other large series and demonstrate the safety and effectiveness of the translabyrinthine approach in excising acoustic neuromas.