Acta Neurochirurgica

, Volume 161, Issue 11, pp 2265–2269 | Cite as

Hearing preservation in vestibular schwannoma surgery via retrosigmoid transmeatal approach

  • Ken Matsushima
  • Michihiro KohnoEmail author
  • Nobuyuki Nakajima
How I Do it - Tumor - Schwannoma
Part of the following topical collections:
  1. Tumor – Schwannoma



Advances in various diagnostic and/or treatment modalities, including radiological imaging, neuromonitoring, and microsurgical techniques, have resulted in treatments of vestibular schwannomas being aimed at preserving facial and hearing functions while achieving optimal tumor control.


We describe our surgical technique for hearing preservation in vestibular schwannoma surgery.


The retrosigmoid transmeatal approach under continuous neuromonitoring (auditory brainstem response, cochlear nerve action potentials, and continuous facial nerve monitoring) enables gross-total resection of vestibular schwannomas, while preserving hearing and facial functions. Radiological assessment and microsurgical techniques, such as meticulous tumor dissection, are also essential for functional preservation with sufficient tumor removal.


Acoustic neuroma Cerebellopontine angle tumor Internal acoustic meatus Lateral suboccipital approach Neuromonitoring Skull base surgery 



Auditory brainstem response


Cranial nerve


Cochlear nerve action potentials


Computed tomography


Magnetic resonance imaging


Somatosensory evoked potential



We thank Ms. Miki Hioki and Mr. Yoshifumi Kawaguchi for their support as medical technologists.

Compliance with ethical standards

Informed consent

Informed consent was obtained from a participant included in this study.

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

Video 1

This video shows hearing preservation surgery for a left vestibular schwannoma via the retrosigmoid transmeatal approach under ABR, CNAP, and continuous facial nerve monitoring. (MP4 237191 kb)


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Copyright information

© Springer-Verlag GmbH Austria, part of Springer Nature 2019

Authors and Affiliations

  • Ken Matsushima
    • 1
  • Michihiro Kohno
    • 1
    Email author
  • Nobuyuki Nakajima
    • 1
  1. 1.Department of NeurosurgeryTokyo Medical UniversityTokyoJapan

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