2026 Proffered Presentations
S126: PREDICTORS OF THIRTY-DAY POST-OPERATIVE SURGICAL COMPLICATIONS IN VESTIBULAR SCHWANNOMA PATIENTS.
Lourdes Kaufman1; Rithvik Ramesh, BA1; Stephanie Younan, BS, MPH1; Ruben Hernandez, BS1; Nadeem Al-Adli, MD2; Steven W Cheung, MD1; Philip V Theodosopoulos, MD1; Ramin Morshed, MD1; Nicole T Jiam, MD1; 1University of California, San Francisco; 2University of North Carolina at Chapel Hill
Introduction: Resection of vestibular schwannomas can result in a range of surgical complications, including cerebrospinal fluid (CSF) leaks, infection, hemorrhage, facial weakness, in addition to other events. Prior literature has emphasized tumor size as a key independent factor that predicts outcomes in VS resection, but most studies use 2-dimensional measurements, which are known to be less accurate. Moreover, most studies on VS complications investigate clinical factors, with few integrating sociodemographic factors, which may be just as important in predicting outcomes. We therefore aimed to characterize and identify predictors of 30-day postoperative surgical complications taking 3-dimensional (3D) tumor volume and sociodemographic factors into account.
Methods: Patients who underwent vestibular schwannoma resection at a large urban tertiary care center between 2004 and 2024 were retrospectively identified. Individuals undergoing reoperation for tumor recurrence were excluded. Thirty-day postoperative complications were determined through review of electronic medical records. Demographic and clinical variables, including age, sex, race, ethnicity, primary language, insurance, CDC-Social Vulnerability Index, Body Mass Index, Charlson Comorbidity Index, ≥6-month observation prior to surgery, pre-treatment hydrocephalus, surgical approach, operative time, 3D tumor size, and extent of resection were compared between patients with and without any 30-day postoperative surgical complication. An additional analysis to identify risk factors for CSF leak, the most common complication, was performed. Variables associated with 30-day CSF leak on univariate analysis (p<0.200) were subsequently entered into a multivariable logistic regression model; adjusted odds ratios (aOR) and 95% confidence intervals (CI) were reported. Post-hoc z-tests for independent proportions were used with Bonferroni correction to identify significantly different subgroups across each variable.
Results: Of the 332 patients included in our final analytic cohort, 45 (13.6%) patients experienced at least one 30-day postoperative surgical complication. Of those, 46.7% had a CSF leak, 20.0% had a wound-related complication, 17.8% had pseudomeningocele, 11.1% had intracranial hemorrhage, 8.9% had meningitis, 6.7% had hydrocephalus, and 20.0% had other complications (including abdominal hematoma at site of fat graft, anesthetic complications, apneic event from excessive CSF drainage, arm weakness, tongue numbness, pneumothorax, subgaleal fluid collection, Vancomycin-Resistant Enterococcus ventriculitis). Having any 30-day post-operative surgical complication was associated with male sex (p=0.006), translabyrinthine surgical approach (p<0.001), and longer operative time (p=0.010). CSF leak within 30 days was associated with Medicaid insurance (p=0.035), translabyrinthine approach (p=0.007), and gross total resection (p=0.002). On multivariate analysis, only Medicaid insurance was found to be significantly associated with CSF leak within 30 days (aOR 5.06 [95% CI 1.31-21.9], p = 0.021).
Conclusions: Medicaid insurance was independently associated with 30-day postoperative CSF leak following vestibular schwannoma resection in the 21 patients who developed this complication. Tumor volume did not predict CSF leak. This association may reflect unmeasured social or behavioral factors, such as differences in access to follow-up care or adherence to postoperative restrictions, which merit further study to inform targeted interventions.
