Clinical Staging to Estimate the Probability of Severe Postoperative Complications in Patients With Vestibular Schwannoma

Question Can a clinical staging system in addition to tumor size predict severe surgical complications in patients with vestibular schwannoma? Findings In this cohort study of 185 patients undergoing surgical resection of their vestibular schwannoma, a 4-stage clinical staging system was developed based on symptoms at presentation and tumor size. With a C index of 0.754, this classification system showed good discriminative ability for severe surgical complications. Meaning This study presents a staging system using clinical symptoms at presentation that may prognosticate complications in patients with vestibular schwannoma. IMPORTANCE Vestibular schwannomas have long been treated as a homogeneous entity. Clinical symptoms at presentation may help elucidate the underlaying pathophysiologic characteristics of tumor subtypes. Describing the heterogeneity of these benign tumors may assist in predicting clinical outcomes associated with their treatment. OBJECTIVE To create a tumor staging system that incorporates symptoms at presentation and tumor size to predict severe surgical complications. DESIGN, SETTING, AND PARTICIPANTS A retrospective cohort of patients at a single-center tertiary referral center from January 1, 1998, to October 13, 2020, was studied. Patients diagnosed with sporadic vestibular schwannoma surgically treated at Washington University in St Louis, Missouri, were included. MAIN OUTCOMES AND MEASURES Severe surgical complications within 30 days of surgery as determined by the Clavien-Dindo classification system. Patients experiencing a complication of grade 3 or above were determined to have a severe complication. RESULTS Of 185 patients evaluated, 40 (22%) had severe postoperative complications. Twenty of the 40 patients (50%) were women; mean (SD) age was 46 (13) years. Patients with severe complications were more likely to have large tumors (>2.5 cm in largest diameter), vestibular symptoms, and recent hearing loss at presentation. Using conjunctive consolidation, a 4-stage clinical severity staging system that incorporates clinical symptoms and tumor size at presentation was created to predict severe complications. The clinical severity staging system demonstrated an improvement in the ability to discriminate severe complications (C index, 0.754; 95% CI, 0.67-0.84) from a model of tumor size alone (C index, 0.706; 95% CI 0.62-0.79). CONCLUSIONS AND RELEVANCE This cohort study found that, among patients with vestibular schwannoma, symptoms present at initial evaluation, in addition to tumor size, served as predictors of severe postoperative complications. A new clinical severity staging system incorporating symptoms at presentation can be helpful for clinicians to identify patients at high risk for severe postoperative complications. This cohort study presents a staging system to predict severe surgical complications in patients who undergo surgical resection of vestibular schwannoma.