Short-Term Surgical Outcome for Vestibular Schwannoma in Sweden: A Nation-Wide Registry Study

Bártek, Jiří; Förander, Petter; Thurin, Erik; Wangerid, Theresa; Henriksson, Roger; Hesselager, Göran; Jakola, Asgeir Store

doi:10.3389/fneur.2019.00043

Cited by 17 publications

(24 citation statements)

References 54 publications

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“…In surgery for vestibular schwannoma, the incidence of new NDs was as high as 31%. 15 Compared with these studies, the incidence of postoperative NDs in the current study was relatively low. It may be because our study was limited to only 24 hours.…”

Section: Postoperative New Neurological Deficitscontrasting

confidence: 56%

Postoperative Neurological Complications after a Cranial Surgery: A Multicentre Prospective Observational Study

Venkatapura

Dubey

Panda

et al. 2020

Journal of Neuroanaesthesiology and Critical Care

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Background Cranial surgery is associated with multiple postoperative complications varying from simple nausea and vomiting to devastating complications such as stroke and death. This multicentre collaborative effort was envisioned to collect observational data regarding postoperative complications in cranial surgeries among the Indian population. The aim of this study was to describe the postoperative neurological complications occurring within the first 24 hours after surgery and to identify the predictive factors. Methods Data was collected from three participating tertiary care academic institutions. The study was prospective, observational, multicentre design with data collected over a period of two months or 100 cases, whichever is earlier, from each participating institute. A predesigned Microsoft excel sheet was distributed among all three centers to maintain uniformity. All patients aged 18 years and above of both sexes undergoing elective or emergency craniotomies were included in the study. The postoperative neurological complications (within 24 hours) assessed were: (1) Neurological deficit (ND) defined as new focal neurological motor deficit relative to preoperative status. (2) Sensorium deterioration (SD) defined as reduction in Glasgow coma score (GCS) by 2 or more points compared with preoperative GCS. (4) Postoperative seizures (SZs) defined as any seizure activity. All possible variables associated with the above neurological complications were tested using Chi-square/Fisher exact test or Mann–Whitney U test. The predictors, which were statistically significant at p < 0.2, were entered into a multiple logistic regression model. Alpha error of 5% was taken as significant. Results Data from three institutions was collected with a total of 279 cases. In total, there were 53 (19%) neurological complications. There were 28 patients with new postoperative NDs (10.04%), 24 patients had SD (8.6%), and 17 patients had seizures (6.1%). Neurological deficits were significantly less in institution 2. Diagnosis of traumatic brain injury (TBI) was associated with very low risk of ND, and vascular pathology was associated with higher chance of a ND. The duration of anesthesia was found to be significantly predictive of SD (OR/CI = 1.01 / 1–1.02). None of the factors were predictive of PS. Conclusion The incidences of postoperative ND, SD and postoperative seizures were 10%, 8.6%, and 6.1%, respectively. Studies with a much larger sample size are required for a better and detailed analysis of these complications.

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Section: Postoperative New Neurological Deficitscontrasting

confidence: 56%

Postoperative Neurological Complications after a Cranial Surgery: A Multicentre Prospective Observational Study

Venkatapura

Dubey

Panda

et al. 2020

Journal of Neuroanaesthesiology and Critical Care

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“…As with drug use, the rate of sick leave after VS surgery in our material is strikingly low compared to meningioma patients during the same time in the same region [ 42 ]. Compared to meningioma patients, VS patients appear less affected by their disease before surgery and the risk for complications affecting the ability to work in this patient group is lower [ 1 , 5 ].…”

Section: Discussionmentioning

confidence: 99%

“…For meningiomas, the reason is more elusive but could be related to that the outcome after VS surgery is generally more predictable, as meningiomas have a higher degree of variance concerning tumor location and symptoms and can cause seizures or cognitive symptoms. Meningioma surgery is also associated with a higher risk for complications than VS surgery [1,5]. Sedatives are mainly prescribed for symptoms of anxiety and sleep disorders.…”

Section: Drug Usementioning

confidence: 99%

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Depression and ability to work after vestibular schwannoma surgery: a nationwide registry-based matched cohort study on antidepressants, sedatives, and sick leave

et al. 2021

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Background In patients with vestibular schwannomas (VS), tumor control is often achieved, and life expectancy is relatively good. The main risks of surgical treatment are hearing loss and facial nerve function. The occurrence of mood and sleeping disorders in relation to surgery is an important aspect of health that has rarely been studied. Similarly, only limited data exist on the rate of sick leave for patients with VS. In this nationwide registry-based study, we define the use of antidepressants and sedatives and the sick leave pattern before and after VS surgery. Methods Adult patients with histopathologically verified VS were identified in the Swedish Brain Tumor Registry (SBTR) and clinical data were linked to relevant national registries after assigning five matched controls to each patient. We studied patterns of dispensed antidepressants and sedative drugs as well as patterns of sick leave compared to respective controls at 2 years before and 2 years following surgery. Results We identified 333 patients and 1662 matched controls. The rate of antidepressant use was similar between patients and controls 2 years before surgery (6.0% vs 6.3%) and 2 years after surgery (10.1% vs 7.5%). The rate of sedative use was also similar 2 years before surgery (3.9% vs 4.3%) and 2 years after surgery (4.8% vs 5.3%). The rate of sick leave was similar at baseline between patients and controls, but at 2 years after surgery, 75% of patients vs 88% of controls (p < 0.01) had no registered sick leave. Long-term sick leave after surgery was predicted by use of sedatives (OR 0.60, 95% CI 0.38–0.94, p = 0.03), more preoperative sick leave (OR 0.91, 95% CI 0.89–0.93, p < 0.001), and new-onset neurological deficits after surgery (OR 0.42, 95% CI 0.24–0.76, p = 0.004). Conclusion This nationwide study shows no significant differences in the use of antidepressants and sedatives between patients and controls, while the rate of postoperative sick leave was higher in patients than in controls after VS surgery. Our findings underpin the importance of avoiding surgical sequelae and facilitating return to normal professional life.

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“…A new neurologic deficit, for instance, is a frequent AE occurring after neurosurgical procedures. [6][7][8][9][10][11] Although they may imply dramatic consequences on quality of life, 12 such events are usually considered as low grade in grading schemes that are solely therapy-based; such concerns have repeatedly been expressed in the literature. 2,8,[13][14][15][16] Scales that assess disability such as the modified Rankin Scale (mRS), 17 or neurologic deficits such as the National Institutes of Health Stroke Scale (NIHSS) have been shown to be good predictors of the quality of life months after central nervous system lesions.…”

Section: Introductionmentioning

confidence: 99%

Adverse Events in Surgical Neurology: The Novel Therapy-Disability-Neurology (TDN) Grade

Terrapon

Zattra

Voglis

et al. 2020

Preprint

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Background The most widely used classifications of adverse events (AE) in surgical neurology assign a grade to AE that depends on the therapy used to treat them or on new neurologic deficits. Both concepts have substantial shortcomings in grading AE severity. We present a novel multidimensional approach to this challenge and aim at validating the new grading system. Methods The new Therapy-Disability-Neurology (TDN) grading system classifies AE into five grades, depending on the associated therapy, disability, and neurologic deficits. We conducted a two-center study on 6071 interventions covering the whole neurosurgical spectrum with data prospectively recorded between January 2013 and September 2019 at the University Hospital Zurich (USZ) and at the Fondazione IRCCS Istituto Neurologico Carlo Besta (FINCB). Findings Using data from USZ, a positive correlation was found between the severity of AE and the length of hospital stay (LOS) as well as treatment cost. Each grade was associated with a greater deterioration of the Karnofsky Performance Status Scale (KPS) at discharge and at follow-up. Additionally, there was a correlation between the severity of AE and absolute KPS values. When using the same methods on an external validation cohort from FINCB, correlations between the grade of AE, LOS, and KPS at discharge were even more pronounced. Interpretation Our results suggest that the TDN grade is consistent with clinical and economic repercussions of AE and thus reflects AE severity. It is objective, practical, easily interpreted, and enables comparison between different medical centers. The TDN grade will constitute an important step forward towards a more precise and standardized documentation of AE and ultimately lead to a more critical and patient-centered appraisal of process and outcome measures in surgical neurology. Funding None.

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Short-Term Surgical Outcome for Vestibular Schwannoma in Sweden: A Nation-Wide Registry Study

Cited by 17 publications

References 54 publications

Postoperative Neurological Complications after a Cranial Surgery: A Multicentre Prospective Observational Study

Postoperative Neurological Complications after a Cranial Surgery: A Multicentre Prospective Observational Study

Depression and ability to work after vestibular schwannoma surgery: a nationwide registry-based matched cohort study on antidepressants, sedatives, and sick leave

Adverse Events in Surgical Neurology: The Novel Therapy-Disability-Neurology (TDN) Grade

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