ObjectiveTo review complications that occur during the course of acoustic neuroma surgery.Study DesignDatabase and retrospective case review.SettingTertiary referral center, private neurotologic practice.PatientsA series of 1,687 patients undergoing acoustic neuroma surgery between 1987 and 1997. The 822 male and 865 female patients ranged in age from 10 to 87 years (mean age at time of surgery, 50 yr; standard deviation, 14 yr). The most common surgical approach was translabyrinthine (72.5%), followed by middle fossa (25.7%). The tumors ranged in size from 3 to 7 cm in diameter (mean, 2.0 cm; SD, 1.1 cm).Main Outcome MeasureFrequency of occurrence of all surgical and medical complications.ResultsThe most common complications were cerebrospinal fluid leaks (9.4%; 2.1% requiring reoperation) and meningitis (1.5%). Other surgical complications included cerebral edema, hydrocephalus, pneumocephalus, lower cranial nerve dysfunction, and wound infection. Medical complications in order of frequency included cystitis, sacral root syndrome, anemia, and pneumonia/bronchitis. Complications were related to tumor size and diagnosis of neurofibromatosis type 2.ConclusionsPerioperative complications will occur with acoustic neuroma surgery, but the overall rate in this large series was low. The authors believe that this supports an aggressive treatment approach for management of acoustic tumors. The findings of this study provide a basis for comparison with other treatment approaches and also are useful for preoperative patient counseling.