Suboccipital retrosigmoid approach for removal of vestibular schwannomas: facial nerve function and hearing preservation.
In this report, we discuss the pertinent bony, arachnoid, and neurovascular anatomy of vestibular schwannomas that has an impact on the surgical technique for removal of these tumors, with the goal of facial nerve and hearing preservation. The surgical technique is described in detail starting with anesthesia, positioning, and neurophysiological monitoring and continuing with the exposure, technical nuances of tumor removal, hemostasis, and closure. Positive prognostic factors for hearing preservation are also highlighted.
Ciric
Ivan
I
Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, and Evanston Northwestern Healthcare, Evanston, Illinois, USA.
Zhao
Jin-cheng
JC
Rosenblatt
Sami
S
Wiet
Richard
R
O'Shaughnessy
Brian
B
D000768:Anesthesia, General; D001099:Arachnoid / Q000033:anatomy & histology; D003056:Cochlear Nerve / Q000033:anatomy & histology; D004388:Dura Mater / Q000601:surgery; D004576:Electromyography; D004711:Endolymphatic Duct / Q000033:anatomy & histology; D016057:Evoked Potentials, Auditory, Brain Stem; D005154:Facial Nerve / Q000033:anatomy & histology; D020220:Facial Nerve Injuries / Q000209:etiology / Q000517:prevention & control*; D006319:Hearing Loss, Sensorineural / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D008416:Mastoid / Q000033:anatomy & histology; D016343:Monitoring, Intraoperative; D009464:Neuroma, Acoustic / Q000601:surgery*; D019635:Neurosurgical Procedures / Q000379:methods; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control*; D011379:Prognosis; D012665:Semicircular Canals / Q000033:anatomy & histology