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Abstract

Objective

Describe the incidence, risk factors, and outcomes of postoperative vagal palsy in patients undergoing surgical excision of cerebellopontine angle (CPA) tumors.

Study Design

Case series with chart review.

Setting

Academic tertiary care center.

Subjects and Methods

One hundred eighty-one consecutive patients undergoing surgical excision of CPA pathology from January 1, 2008, to December 31, 2010, at Johns Hopkins Hospital. Postoperative unilateral vagal palsy was identified by laryngoscopy or videofluoroscopy, and clinical variables were collected from medical records.

Results

Postoperative unilateral vagal palsy was identified in 19 of 181 (10%) patients. Vocal fold motion impairment (VFMI) in combination with pharyngeal palsy was more common than VFMI or pharyngeal palsy alone. Those with vagal palsy had a larger mean tumor size (30 mm) than those without vagal palsy (20 mm, P = .0002) and a significantly longer mean hospital stay (9 vs 5 days, P < .0001). Vagal palsy was not associated with tumor pathology, prior treatment (stereotactic radiation or prior surgery), or surgical approach (suboccipital craniotomy vs translabyrinthine approach). Significant rates of aspiration were observed in patients with vagal palsy (67%).

Conclusion

Voice and swallowing function can be affected by surgical excision of pathology of the CPA. Tumor size is an independent risk factor for postoperative vagal palsy, which in turn has important consequences for prolonged hospital stay, aspiration, and voice and swallowing impairment.

Keywords

cerebellopontine angle (CPA)dysphonia dysphagia

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References

Hastan

Vandenbroucke

van der Mey

. A meta-analysis of surgical treatment for vestibular schwannoma: is hospital volume related to preservation of facial function? Otol Neurotol. 2009;30:975-80.

Sameshima

Fukushima

McElveen

Friedman

. Critical assessment of operative approaches for hearing preservation in small acoustic neuroma surgery: retrosigmoid vs middle fossa approach. Neurosurgery. 2010; 67:640-4.

Sampath

Rini

Long

. Microanatomical variations in the cerebellopontine angle associated with vestibular schwannomas (acoustic neuromas): a retrospective study of 1006 consecutive cases. J Neurosurg. 2000;92:70-78.

Fang

Tam

Courey

Chiang

. Unilateral high vagal paralysis: relationship of the severity of swallowing disturbance and types of injuries. Laryngoscope. 2011; 121:245-9.

Pou

Carrau

Eibling

Murry

. Laryngeal framework surgery for the management of aspiration in high vagal lesions. Am J Otolaryngol. 1998;19:1-7.

Ryzenman

Pensak

Tew

. Patient perception of comorbid conditions after acoustic neuroma management: survey results from the acoustic neuroma association. Laryngoscope. 2004;114:814-20.

Rosenbek

Robbins

Roecker

Coyle

Wood

. A penetration aspiration scale. Dysphagia. 1996;11:93-98.

Zhang

Fei

Chen

. Facial nerve function after excision of large acoustic neuromas via the suboccipital retrosigmoid approach. J Clin Neurosci. 2005;12:405-8.

Kazim

Shamim

Enam

Bari

. Microsurgical excisions of vestibular schwannomas: A tumor-size-based analysis of neurological outcomes and surgical complications. Surg Neurol Int. 2011;31:41.

10.

Samii

Greganov

Samii

. Functional outcome after complete surgical removal of giant vestibular schwannomas. J Neurosurg. 2010; 112:860-7.

11.

Altman

Schaefer

. Consequence of dysphagia in the hospitalized patient: impact on prognosis and hospital resources. Otolaryngol Head Neck Surg. 2010;136:784-9.

12.

Randolph

Dralle

Abdullah

. Electrophysiologic recurrent laryngeal nerve monitoring during thyroid and parathyroid surgery: international standards guideline statement. Laryngoscope. 2011; 121:S1-16.

13.

Oestreicher-Kedem

Agrawal

Damrose

. Surgical rehabilitation of voice and swallowing after jugular foramen surgery. Ann Otol Rhinol Laryngol. 2010;119:192-8.

14.

Netterville

Vrabec

. Unilateral palatal adhesion for paralysis after high vagal injury. Arch Otolaryngol Head Neck Surg. 1994;120:218-21.

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Risk Factors for Vagal Palsy following Cerebellopontine Angle Surgery