Retrosigmoid Approach for Vestibular Schwannoma Surgery

  • Pınar Eser Ocak
  • Ihsan Dogan
  • Sima Sayyahmelli
  • Mustafa K. BaskayaEmail author


The retrosigmoid approach offers hearing preservation for small and medium-sized vestibular schwannomas while providing excellent exposure of the cerebellopontine angle and lateral cerebellomedullary cisterns that contain critical neurovascular structures. A 3 × 3 cm retrosigmoid craniotomy with exposure of the TSSJ and an approximately 1/4 of the medial border of the sigmoid sinus is sufficient enough in many cases of VS surgeries. With small and medium-sized tumors, the initial exposure of the tumor includes its lateral part of the tumor, the AICA and its subarcuate branch, the lower cranial nerves and the PICA in the inferior aspect of the tumor, as well as the petrosal vein in the rostral aspect. Good postoperative FN function can be achieved by, maintaining the blood supply of the FN, minimizing bipolar coagulation around the nerve, preserving the arachnoid plane between the tumor and the FN, and keeping the tumor capsule intact during internal decompression. Surgical precautions to achieve a better postoperative hearing outcome include; gentle manipulation of the CoN, obtaining meticulous hemostasis, providing a bloodless surgical field, protecting the labyrinthine artery, avoiding excessive retraction of the cerebellum and compression of the brainstem, preservation of veins, keeping the drilling field clean to avoid aseptic meningitis, and appropriate monitoring of the CoN during the surgery. Complications of the surgery may include; cranial nerve dysfunctions such as facial, cochlear, and lower cranial nerves, CSF leak and meningitis, headache, disequilibrium, tinnitus, and also tumor recurrence.


Vestibular schwannoma Acoustic neuroma Retrosigmoid approach Facial nerve Cerebellopontine angle Hearing preservation 

Supplementary material

Video 4.1

Microsurgical resection of vestibular schwannoma with hearing preservation via retrosigmoid approach: 2D operative video (ZIP 824145 kb)

Video 4.2

Retrosigmoid approach: demonstration of opening and closure (ZIP 257163 kb)

Video 4.3

Demonstration of retrosigmoid approach in cadaveric dissection: 3D video (ZIP 403036 kb)

Video 4.4

Gross total resection of vestibular schwannoma with hearing preservation via retrosigmoid approach: 3D operative video (ZIP 415684 kb)


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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Pınar Eser Ocak
    • 1
  • Ihsan Dogan
    • 1
  • Sima Sayyahmelli
    • 1
  • Mustafa K. Baskaya
    • 1
    Email author
  1. 1.Department of Neurological SurgeryUniversity of Wisconsin School of Medicine and Public HealthMadisonUSA

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