Incidence and predictors of bulbar palsy after surgery for acoustic neuroma.

We present a retrospective review of the perioperative management and complications of 102 cases of acoustic neuroma operated on at an English teaching hospital over the last 9 years. Nine patients had a bulbar palsy postoperatively; five of those patients developed pulmonary complications. A bulbar palsy was more likely to occur in those with tumours > or = 3 cm. The occurrence of intraoperative bradycardias, present in nearly half of the bulbar palsy cases, did not help predict who would sustain this injury postoperatively. However, episodes of intraoperative hypotension served to better predict a bulbar palsy complication in conjunction with the presence of a large tumour. Post-operative airway management is an area of possible conflict of interest: the desire for early extubation to avoid the possibility of coughing and bucking on the endotracheal tube and the need to protect the airway of the patient with a lower cranial nerve deficit. Almost 10% of our patients did have such a deficit after surgery; and over half of them developed respiratory complications making this an important cause of postoperative morbidity. We recommend that the timing of extubation be judged on an individual basis for each patient. Those with tumours > or = 3 cm warrant particular concern. All patients should receive careful observation in a high dependency area for at least the first postoperative day.