No abstract

The surgical plane between the VIIth nerve and acoustic tumor is often elusive. This histological relationship was reviewed in three patients who underwent VII-VII neuroanastomosis at tumor removal disclosing an inseparable surgical plane in two. In the third patient, tissue sections did not accurately show the relationship. In all three, surgical planes were not apparent at tumor removal. Another patient had a second, isolated tumor in the same VIIIth nerve proximally at the brain stem root entry zone. This was seen only on permanent section. In considering "total" tumor removal by microsurgical standards, these histological findings should be kept in mind. We advocate removal of the entire VIIIth nerve to the brain stem root entry zone along with smaller tumors.

No abstract

Surgery for acoustic tumors has several priorities. First and foremost is the preservation of life with the total removal of the tumor; second is the preservation of the facial nerve; and last, when applicable, is the preservation of hearing. During the suboccipital (retrosigmoid) removal of a tumor, the surgeon unknowingly may leave tumor remnants leading to regrowth. We present five cases of recurrent acoustic tumors after a suboccipital removal. Inadequate drilling exposure of the internal auditory canal was the probable direct cause for tumor recurrence. A translabyrinthine removal is the best approach for total exposure of the entire internal auditory canal. The consequences of small tumor remnants will be discussed as well as their clinical relevance. Current radiological imaging and surgical techniques that avoid residual tumor will be presented.