Results of the Translabyrinthine Approach in Acoustic Neuroma Surgery

Objective: The authors review the results of a series of 24 acoustic neuromas that were surgically treated via the translabyrinthine approach by the otoneurosurgical team of our hospital.

Material and Methods: A total of 24 surgeries were performed in 21 consecutive patients. The main presentation symptoms were hearing loss, tinnitus, and, rarely, ataxia or facial palsy (one patient with House-Brackmann (H-B) grade II and one with grade VI) or paresthesia. Seventeen patients (81%) were female, and 57% had left-sided tumors. Seventeen patients were between 31 and 70 years-old. Most tumors (81%) were smaller than 30 mm, and only three were larger than 40 mm.

Results: Total tumor removal was accomplished in 21 cases, and 3 patients needed second surgery for residual tumor. The facial nerve was anatomically preserved in 23 surgeries. In the only case that was incidentally divided, anastomosis with sural graft was performed. Facial nerve function was assessed at the time of discharge and 6 months after discharge. Excellent function (H-B grade I and II) was present in 53% and 63%, respectively. Bad function (H-B grade V or VI) was present in 10% of cases at discharge and 6 months after. Cerebrospinal fluid leakage that required surgical repair occurred in three patients. There were no deaths or infections reported.

Conclusions: In our series, use of the translabyrinthine approach for removal of acoustic neuromas resulted in good anatomical and functional preservation of the facial nerve, with minimum incidence of morbidity and no mortality.