Hearing Preservation following Combined Approach Middle Cranial Fossa and Retrosigmoid for Cerebellopontine Angle and Internal Auditory Canal Tumors

Introduction: Vestibular schwannomas are benign neoplasms of Schwann cell origin which constitute 85% of all tumors in the region of the cerebellopontine angle (CPA) and internal auditory canal (IAC. Considering its benign nature and the potential surgical morbidity related to the complex anatomy of the CPA and IAC, vestibular schwannomas remain among the most challenging of tumors to remove at the cranial base for neurosurgeons and neurotologists.

Materials and Methods: Here, we describe our initial experience of hearing preservation and hearing outcomes following vestibular schwannoma resection of IAC and CPA via novel combined middle cranial fossa and retrosigmoid approach. Hearing was evaluated by bedside hearing test at postoperative day 1 for all patients.

Results: Tow patients with vestibular schwannomas had complete resection of their tumors via retrosigmoid and middle cranial fossa combined approach. Following surgery, hearing was preserved in patients resulted in moderate hearing loss, two females aged 56 and 57 years old. In our patients, there was no evidence for tumor recurrence within follow up time of 12 months. Facial function was HB 1 and HB 4.

Conclusion: Aiming for complete gross tumor resection with hearing preservation, the choice of surgical approach and grade of resection must be carefully assessed and should be individualized differentially to each patient, while also considering the experience and preference of the surgical team. Complete resection is the treatment of choice when the tumor is amenable to total removal. Single-stage middle cranial fossa approach combined with retrosigmoid approach appear to be a safe and feasible technique, capable of achieving total or near total resection in most cases with identified lesions at the IAC and CPA.

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Artikel online veröffentlicht:
07. Februar 2025