Anesthesia for excision of vestibular schwannoma

Anesthesia for the resection of vestibular schwannomas poses unique challenges; operative times are long, typically between 8 and 12h, during which there are varying levels of surgical stimulation. Close attention to positioning is essential to minimize skin damage, neuropraxia, and optimize surgical access. The delicate nature of microsurgical resection requires absolute patient immobility; this is made more demanding by the need to avoid neuromuscular blocking drugs to facilitate continuous electromyographic (EMG) monitoring of the facial nerve. The choice of anesthetic should enable this and allow for prompt postoperative assessment of neurologic function after prolonged exposure to these agents. Surgery on the vestibular apparatus can be a potent stimulus for postoperative nausea and vomiting, and postoperative control of these symptoms is important in order to optimize recovery.