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 trans labyrinthine 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 patie nts had a histologically proven diagnosis of acoustic neuroma. Results: There were no deaths. There were 3 cases (1.1%) of neurovascular c ompromise. There were 20 cases (7.8%) of cerebrospinal fluid leak, 16 (80%) of which presented as rhinorrhea and 4 (20%) as incisional leaks. The leak s at the incision responded to conservative management, while rhinorrhea us ually 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 th e 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 translaby rinthine approach in excising acoustic neuromas.