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The most common complications of acoustic neuroma surgery include:

• Cerebrospinal fluid (CSF) leakage
• Postoperative headaches
• Facial nerve complications
• Vestibular nerve dysfunction

Cerebrospinal Fluid Leakage

Leakage of cerebrospinal fluid through the surgical site or through the Eustachian tube and middle ear occurs in up to 20% of patients following acoustic neuroma surgery. It occurs most frequently following suboccipital surgery and the least following middle fossa surgery. Meningitis may occur in up to 5% of these patients. Cerebrospinal leakage may be corrected either by placing an extra stitch at the surgical site, by re-closure of the operative site, or by placement of a temporary lumbar drainage catheter.

Postoperative Headaches

Postoperative headaches are experienced by most patients who undergo acoustic neuroma surgery. They may be due to several factors, including:

• Pain from the incision
• Muscle pain
• Disturbances of cerebrospinal fluid pressure

In some patients, postoperative headaches persist for months or years after surgery. There is debate whether a relationship exists between tumor size and the incidence of postoperative headaches. It appears from some studies that the patient group at highest risk of suffering persistent postoperative headaches are those with small tumors (< 1 cm diameter) operated via a suboccipital approach for hearing conservation purposes.

Facial Nerve Complications

"Acceptable" long-term facial nerve function after surgery is reported to occur in 60% to 100% of patients with an average of 85%. Severe injury to the facial nerve can result in speech impairment, drooling, difficulty chewing and swallowing, and the loss of taste. The degree of facial nerve dysfunction following surgery is impossible to predict.

Limited paralysis or paresis of facial muscles may occur if the tumor is compressing the facial nerve, such as if the acoustic neuroma is attached to the facial nerve or wrapped around it. Under certain circumstances, the facial nerve can be surgically repaired at the time of surgery which delays considerably the recovery period of facial nerve function. If facial paralysis does occur, special attention must be given to the eye since the ability to blink may be affected.

With the presence of facial nerve weakness, the patient may also experience difficulty completely closing their eye resulting in exposure and drying of the cornea. The feeling most typically associated with this problem is that of sand or some other foreign particles in the eye and causing significant irritation. It is very important for the patient to keep their eyes well hydrated by using artificial teardrops as need and perhaps eye ointment at night.

Vestibular Nerve Dysfunction

Since an acoustic neuroma is situated directly on the vestibular nerve, any surgical procedure to remove the tumor will necessarily involve manipulation of the nerve to some degree or direct injury to the vestibular nerve. The severity of nerve damage preoperatively determines how quickly the brain will compensate in restoring equilibrium. If the patient had good preoperative vestibular function and the nerve on the affected side is functioning relatively well, then the symptoms following surgery will be more pronounced than if the tumor had already destroyed part of the nerve. In this case, the brain will have already compensated for the lack of vestibular information input from the affected ear and, postoperatively, vestibular dysfunction will be minimal.