The Impact of Class III Obesity on Outcomes for Vestibular Schwannoma Surgery: A Case Report

Background and Clinical Significance: Vestibular schwannomas (VS) are benign tumors arising from Schwann cells of the eighth cranial nerve. They represent approximately 8% of all intracranial tumors and have an increasing incidence. Larger VS can cause brainstem compression and hydrocephalus, and magnetic resonance imaging (MRI) is the diagnostic modality of choice. Individuals with VS and an elevated body mass index (BMI) can have more postoperative complications due to their weight, which can also negatively impact the preoperative diagnostic process and planning, as well as the surgery itself, as compromises must be made since optimal positioning of the patient is often not feasible. Increased BMI is a recognized risk factor for cerebrospinal fluid (CSF) leak after microscopic resection of a VS. Case Presentation: This report presents a case of a patient with class III obesity who had to undergo a right VS resection with preexisting hydrocephalus and the obstacles encountered by the surgical team throughout the diagnostics process since MRI could not be performed and preoperative planning had to be based on computed tomography (CT) scan; operative treatment, where suboptimal patient placement was achieved for a planned retrosigmoid approach to the pontocerebellar angle (PCA) and postoperative rehabilitation, which was hindered by his high BMI (55 kg/m²) with several complications, such as CSF leak, due to his extreme weight. Conclusions: Despite barriers, optimal tumor resection was obtained with a long neurorehabilitation process, with a favorable outcome, emphasizing the role of a multidisciplinary team.