|Co-Author(s):||Dokianakis G., Kotselas V.T., Petsanas D., Kyrgiannis K., Atzemi-|
|Moldow N., Hatzidakis G. I., Georgopoulos Ch. E.|
Background: The purpose is to present the combined transotic – presigmoidal and suboccipital – retrosigmoidal approach for giant acoustic tumors achieving radical tumor resection with preservation of facial nerve function in cases with preoperative hearing loss.
Material and methods: 25 patients (11 men, 14 women – average age 54 years) were operated on with this technique during the last 10 years. All had a unilateral acoustic neuroma larger than 30 cm3 with loss of functional hearing and no facial weakness preoperatively. All operations were performed by the same joined ENT and neurosurgical team. Surgical position is lateral with facial nerve electrophysiological monitoring intraoperatively. Via a “reverse S” retroauricular skin incision, external acoustic meatous is beeing ligated and a mastoidectomy with sigmoid sinus skeletonization is performed. Labyrinthe and cochlea are resected. Bill’s bar and internal acoustic meatus wall are recognised, and the facial nerve coursing the Fallopian canal is carefully dissected and preserved. Then, a suboccipital craniectomy is performed, preserving the sigmoid sinus between the two surgical fields. Tumor internal decompression (using ultrasonic aspirator) and tumor capsule deatachment from the subarachnoid segment of the facial nerve and from the brainstem is performed working via both surgical fields. After completion of tumor resection the wound is closed using muscular graft for covering the Eustachian tube’s opening and subcutaneous fat graft for filling the temporal bone defect.
Results: Radical tumor resection was achieved in all cases. Surgical outcome was excellent in all but one case (death 2 months post-op because of pulmonary infection). Preservation of good facial nerve function was achieved in 19 cases (76%).
Conclusion: Combined transotic and suboccipital approach is very useful for radical tumor resection with facial nerve preservation in cases of giant acoustic neuromas.