Objectives To determine the incidence of prolonged postoperative systemic
corticosteroid therapy after surgery for
acoustic neuroma as well as the indications and associated risk factors that could lead to prolonged
steroid administration, and the incidence of
steroid-related adverse effects. Study Designs Retrospective chart review. Methods Retrospective chart review of patients undergoing resection of
acoustic neuroma between 2010 and 2017 at two tertiary care medical centers. Patient and
tumor characteristics, operative approach, hospital
length of stay, initial postoperative taper length, number of discrete postoperative
steroid courses, and postoperative complications were analyzed. Results There were 220 patients (99 male, 121 female) with an average age of 49.4 (range 16-78). There were 124 left-sided
tumors and 96 right-sided
tumors. Within the group, 191
tumors were operated through a retrosigmoid approach, 25
tumors through a translabyrinthine approach, and 4
tumors with a combined retrosigmoid-translabyrinthine approach under the same
anesthetic. In total, 35 (15.9%) patients received an extended initial course of postoperative systemic
steroids, defined as a taper longer than 18 days. Twenty six (11.8%) patients received additional courses of systemic
steroids after the initial postoperative taper. There were 5 (2.3%) patients who required an extended initial taper as well as additional courses of
steroids.
Aseptic meningitis, often manifested as
headache, was the most common indication for additional
steroids (14 cases of prolonged taper and 17 cases of additional courses). None of the patient or
tumor factors including age, gender, side, size, and approach were statistically significantly associated with either a prolonged initial
steroid taper or additional courses of
steroids. An extended hospital
length of stay was associated with a prolonged initial
steroid taper ( p = 0.03), though the initial taper length was not predictive of additional courses of
steroids. The cumulative number of days on
steroids was associated with need for additional procedures ( p < 0.01) as well as
steroid-related side effects ( p = 0.05). The administration of
steroids was not found to significantly improve outcomes in postoperative
facial paresis.
Steroid-related complications were uncommon, seen in 9.26% of patients receiving
steroids, with the most common being psychiatric side effects such as agitation, anxiety, and mood lability. Conclusions Systemic
corticosteroids are routinely administered postoperatively for patients undergoing
craniotomy for the resection of
acoustic neuromas. In a review of 220 patients operated by a single neurotologist, no patient or
tumor factors were predictive of requiring prolonged initial
steroid taper or additional courses of
steroids. The cumulative number of days on systemic
steroids was associated with undergoing additional procedures and
steroid-related side effects. The most common indications for prolonged or additional
steroids were
aseptic meningitis,
cerebrospinal fluid leak, and
facial paresis. Additional
steroids for postoperative
facial paresis did not significantly improve outcomes. Patient-reported
steroid-related complications were infrequent and were most commonly psychiatric including agitation, anxiety, and mood lability.