CC BY-NC-ND 4.0 · J Neurol Surg B 2019; 80(S 03): S269-S270
DOI: 10.1055/s-0039-1688488
Skull Base: Operative Videos
Georg Thieme Verlag KG Stuttgart · New York

Retrosigmoid Transmeatal Approach for Resection of Acoustic Neuroma: Operative Video and Technical Nuances of Subperineural Dissection for Facial Nerve Preservation

James K. Liu
1  Departments of Neurological Surgery, Center for Cerebrovascular and Skull Base Surgery, Rutgers University, New Jersey Medical School, Neurological Institute of New Jersey, RWJ Barnabas Health, Livingston and Newark, New Jersey, United States
2  Otolaryngology/Head-and-Neck Surgery, Center for Cerebrovascular and Skull Base Surgery, Rutgers University, New Jersey Medical School, Neurological Institute of New Jersey, RWJ Barnabas Health, Livingston and Newark, New Jersey, United States
,
Vincent N. Dodson
1  Departments of Neurological Surgery, Center for Cerebrovascular and Skull Base Surgery, Rutgers University, New Jersey Medical School, Neurological Institute of New Jersey, RWJ Barnabas Health, Livingston and Newark, New Jersey, United States
,
Robert W. Jyung
2  Otolaryngology/Head-and-Neck Surgery, Center for Cerebrovascular and Skull Base Surgery, Rutgers University, New Jersey Medical School, Neurological Institute of New Jersey, RWJ Barnabas Health, Livingston and Newark, New Jersey, United States
› Author Affiliations
Further Information

Address for correspondence

James K. Liu, MD
Department of Neurological Surgery, Rutgers University, New Jersey Medical School
90 Bergen Street, Suite 8100, Newark, NJ 07103
United States   

Publication History

17 March 2019

25 March 2019

Publication Date:
30 April 2019 (online)

 

    Abstract

    The retrosigmoid (suboccipital) approach is the workhorse for most acoustic neuromas in the cerebellopontine angle. In this operative video atlas manuscript, the authors demonstrate the nuances of the subperineural dissection technique for microsurgical resection of an acoustic neuroma via the retrosigmoid transmeatal approach. The plane is developed by separating the perineurium of the vestibular nerve away from the tumor capsule. This perineurium provides a protective layer between the tumor capsule and the facial nerve which serves as a buffer to avoid direct dissection and potential trauma to the facial nerve. Using this technique during extracapsular tumor dissection helps to maximize the extent of tumor removal while preserving facial nerve function. A gross total resection of the tumor was achieved, and the patient exhibited normal facial nerve function ([Fig. 1]). In summary, the retrosigmoid transmeatal approach with the use of subperineural dissection are important strategies in the armamentarium for surgical management of acoustic neuromas with the goal of maximizing tumor removal and preserving facial nerve function ([Fig. 2]).

    The link to the video can be found at: https://youtu.be/L3lPtSvJt60.


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    Zoom Image
    Fig. 1 (A) Preoperative axial T1-MRI with gadolinium demonstrates a Koos's grade 4 acoustic neuroma with brainstem compression. (B) Postoperative T1-MRI demonstrates successful gross total resection and relief of brainstem compression. MRI, magnetic resonance imaging.
    Zoom Image
    Fig. 2 Intraoperative photograph displaying the subperineural plane of dissection between the perineurium of the vestibular nerve and the tumor.

    www.thieme.com/skullbasevideos

    www.thieme.com/jnlsbvideos


    Quality:

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    Conflict of Interest

    None.

    Address for correspondence

    James K. Liu, MD
    Department of Neurological Surgery, Rutgers University, New Jersey Medical School
    90 Bergen Street, Suite 8100, Newark, NJ 07103
    United States   

      
    Zoom Image
    Fig. 1 (A) Preoperative axial T1-MRI with gadolinium demonstrates a Koos's grade 4 acoustic neuroma with brainstem compression. (B) Postoperative T1-MRI demonstrates successful gross total resection and relief of brainstem compression. MRI, magnetic resonance imaging.
    Zoom Image
    Fig. 2 Intraoperative photograph displaying the subperineural plane of dissection between the perineurium of the vestibular nerve and the tumor.