Retromastoid-sub occipital: A novel approach to cerebello pontine angle in acoustic neuroma surgery-our experience in 21 cases

Abstract

Background:Acoustic neuroma surgery poses significant challenges regarding definite management and preservation of hearing and the facial nerve are of great concern.Aim:To analyze the efficacy of the retromastoid approach in acoustic neuroma surgery.Materials and Methods:Tumors operated between January 2002 and December 2008, by the authors, using the retromastoid approach, were analyzed. Twenty-one patients who presented with acoustic tumor were considered for this study.Discussion:Precise knowledge of the neuroanatomy in the cerebellopontine angle is the key to success and microsurgical technique is the sole factor for good outcome.Conclusion:Retromastoid, in fact is the approach to the skull base with minimal or no damage to neurovascular structures, in contrast to the translabyrinthine or presigmoid approach.

Surgical management of vestibular schwannoma: attempted preservation of hearing and facial function

“…House-Brackmann grade I-II) in more than 90 per cent of patients. 7 In our study, 19 tumours were completely excised, 5 of which were cystic. We found that cystic tumours were tightly adherent to the facial nerve or to other cranial nerves, making complete tumour excision more difficult and sometimes impossible without significant risk.…”

“…The inferior portions of the cerebellopontine angle and the posterior surface of the temporal bone anterior to the porus acousticus are clearly observed. 7 The disadvantages of the retromastoid approach are: (1) it may require cerebellar retraction; and (2) manipulation of the cerebellum provides opportunities for post-operative oedema, haematoma, infarction and haemorrhage. 7 Experience has a remarkable influence on the outcome of vestibular schwannoma surgery, as well as on the prevalence of surgical morbidity.…”

“…7 The disadvantages of the retromastoid approach are: (1) it may require cerebellar retraction; and (2) manipulation of the cerebellum provides opportunities for post-operative oedema, haematoma, infarction and haemorrhage. 7 Experience has a remarkable influence on the outcome of vestibular schwannoma surgery, as well as on the prevalence of surgical morbidity. Furthermore, we believe that repeated practice will never cease to enhance the surgeon's skill.…”

“…7 The introduction of microsurgical techniques and electrophysiological monitoring has improved the anatomical and functional preservation of the facial and vestibulocochlear nerves. 13 The primary goal of vestibular schwannoma surgery has changed from preserving the patient's life to preserving their neurological function.…”

“…Vestibular schwannoma surgery poses significant challenges with regard to definitive management. Preservation of hearing and facial nerve function is of great concern 7 . Surgical removal remains the treatment of choice for tumour eradication.…”