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.
