Skip to main content
SpringerLink
Log in

Retrosigmoid Approach

  • Chapter
Advances in Vestibular Schwannoma Microneurosurgery

  • 647 Accesses

Abstract

The retrosigmoid approach is most commonly performed in vestibular schwannoma surgery regardless of the tumor size, especially when hearing preservation is attempted; it is a safe option for small tumors, with low morbidity and good facial nerve and hearing preservation outcomes. A retroauricular C-shaped skin incision is performed after patient preparation and positioning. Keyhole retrosigmoid craniotomy follows, so as to expose sigmoid and transverse sinuses and the dura mater of the posterior fossa, which is then incised. The CSF within the lateral medullary cistern is drained to obtain cerebellar retraction. The internal auditory canal (IAC) is opened under direct microscopic observation. The facial nerve is localized and traced by means of intraoperative neurophysiological monitoring devices. The capsule is elevated and incised to achieve satisfactory tumor debulking. The portion of the tumor within the IAC is removed piecemeal, and the tumor capsule is dissected away from brainstem and cranial nerves.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 79.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 99.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Samii M, Gerganov V, Samii A. Improved preservation of hearing and facial nerve function in vestibular schwannoma surgery via the retrosigmoid approach in a series of 200 patients. J Neurosurg. 2006;105(4):527–35.

    Article  PubMed  Google Scholar 

  2. Wanibuchi M, Fukushima T, Friedman AH, Watanabe K, Akiyama Y, Mikami T, et al. Hearing preservation surgery for vestibular schwannomas via the retrosigmoid transmeatal approach: surgical tips. Neurosurg Rev. 2014;37(3):431–44; discussion 44.

    Article  PubMed  Google Scholar 

  3. Scheller C, Wienke A, Tatagiba M, Gharabaghi A, Ramina KF, Ganslandt O, et al. Stability of hearing preservation and regeneration capacity of the cochlear nerve following vestibular schwannoma surgery via a retrosigmoid approach. J Neurosurg. 2016;125(5):1277–82.

    Article  PubMed  Google Scholar 

  4. Peng KA, Wilkinson EP. Optimal outcomes for hearing preservation in the management of small vestibular schwannomas. J Laryngol Otol. 2016;130(7):606–10.

    Article  CAS  PubMed  Google Scholar 

  5. Satar B, Yetiser S, Ozkaptan Y. Impact of tumor size on hearing outcome and facial function with the middle fossa approach for acoustic neuroma: a meta-analytic study. Acta Otolaryngol. 2003;123(4):499–505.

    Article  PubMed  Google Scholar 

  6. Anaizi AN, DiNapoli VV, Pensak M, Theodosopoulos PV. Small vestibular schwannomas: does surgery remain a viable treatment option? J Neurol Surg B Skull Base. 2016;77(3):212–8.

    Article  PubMed  Google Scholar 

  7. Sameshima T, Fukushima T, McElveen JT, Friedman AH. Critical assessment of operative approaches for hearing preservation in small acoustic neuroma surgery: retrosigmoid vs middle fossa approach. Neurosurgery. 2010;67(3):640–4; discussion 4–5.

    Article  PubMed  Google Scholar 

  8. Mastronardi L, Cacciotti G, Roperto R, Tonelli MP, Carpineta E. How I do it: the role of flexible hand-held 2μ-thulium laser fiber in microsurgical removal of acoustic neuromas. J Neurol Surg B Skull Base. 2017;78(4):301–7.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Mastronardi L, Cacciotti G, Scipio ED, Parziale G, Roperto R, Tonelli MP, et al. Safety and usefulness of flexible hand-held laser fibers in microsurgical removal of acoustic neuromas (vestibular schwannomas). Clin Neurol Neurosurg. 2016;145:35–40.

    Article  PubMed  Google Scholar 

  10. Mastronardi L, Di Scipio E, Cacciotti G, Roperto R. Vestibular schwannoma and hearing preservation: usefulness of level specific CE-Chirp ABR monitoring. A retrospective study on 25 cases with preoperative socially useful hearing. Clin Neurol Neurosurg. 2018;165:108–15.

    Article  PubMed  Google Scholar 

  11. Sameshima T. Fukushima’s microanatomy and dissection of the temporal bone. 2nd ed. In: Sameshima T, editor. Raleigh: AF-Neurovideo, Inc.; 2007. 115 p.

    Google Scholar 

  12. Sameshima T, Mastronardi L, Friedman AH, Fukushima T. Microanatomy and dissection of temporal bone for surgery of acoustic neuroma and petroclival meningioma. 2nd ed. Raleigh: AF Neurovideo, Inc.; 2007.

    Google Scholar 

  13. Mastronardi L, Cacciotti G, Caputi F, Roperto R, Tonelli MP, Carpineta E, et al. Underlay hourglass-shaped autologous pericranium duraplasty in “key-hole” retrosigmoid approach surgery: technical report. Surg Neurol Int. 2016;7:25.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Tatagiba M, Roser F, Schuhmann MU, Ebner FH. Vestibular schwannoma surgery via the retrosigmoid transmeatal approach. Acta Neurochir. 2014;156(2):421–5; discussion 5.

    Article  PubMed  Google Scholar 

  15. Campero A, Martins C, Rhoton A, Tatagiba M. Dural landmark to locate the internal auditory canal in large and giant vestibular schwannomas: the Tübingen line. Neurosurgery. 2011;69(1 Suppl Operative):ons99–102; discussion ons102.

    PubMed  Google Scholar 

  16. Tatagiba MS, Evangelista-Zamora R, Lieber S. Mobilization of the anterior inferior cerebellar artery when firmly adherent to the petrous dura mater-A technical nuance in retromastoid transmeatal vestibular schwannoma surgery: 3-dimensional operative video. Oper Neurosurg (Hagerstown). 2018;15(5):E58–9.

    Google Scholar 

  17. Ebner FH, Kleiter M, Danz S, Ernemann U, Hirt B, Löwenheim H, et al. Topographic changes in petrous bone anatomy in the presence of a vestibular schwannoma and implications for the retrosigmoid transmeatal approach. Neurosurgery. 2014;10(Suppl 3):481–6.

    PubMed  Google Scholar 

  18. Tatagiba MS, Roser F, Hirt B, Ebner FH. The retrosigmoid endoscopic approach for cerebellopontine-angle tumors and microvascular decompression. World Neurosurg. 2014;82(6 Suppl):S171–6.

    Article  PubMed  Google Scholar 

  19. Turek G, Cotúa C, Zamora RE, Tatagiba M. Endoscopic assistance in retrosigmoid transmeatal approach to intracanalicular vestibular schwannomas—an alternative for middle fossa approach. Technical note. Neurol Neurochir Pol. 2017;51(2):111–5.

    Article  PubMed  Google Scholar 

  20. Kumon Y, Kohno S, Ohue S, Watanabe H, Inoue A, Iwata S, et al. Usefulness of endoscope-assisted microsurgery for removal of vestibular schwannomas. J Neurol Surg B Skull Base. 2012;73(1):42–7.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Corrivetti F, Cacciotti G, Giacobbo Scavo C, Roperto R, Mastronardi L. Flexible endoscopic-assisted microsurgical radical resection of intracanalicular vestibular schwannomas by a retrosigmoid approach: operative technique. World Neurosurg. 2018;115:229–33.

    Article  PubMed  Google Scholar 

  22. Nonaka Y, Fukushima T, Watanabe K, Friedman AH, Sampson JH, Mcelveen JT, et al. Contemporary surgical management of vestibular schwannomas: analysis of complications and lessons learned over the past decade. Neurosurgery. 2013;72(2 Suppl Operative):ons103–15; discussion ons15.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Neurosurgery, San Filippo Neri Hospital—ASLRoma1, Rome, Italy

    Luciano Mastronardi, Alberto Campione, Guglielmo Cacciotti, Raffaelino Roperto & Carlo Giacobbo Scavo

  2. Division of Neurosurgery, Duke University Medical Center, Carolina Neuroscience Institute, Raleigh, NC, USA

    Ali Zomorodi & Takanori Fukushima

Authors
  1. Luciano Mastronardi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Alberto Campione
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Guglielmo Cacciotti
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Raffaelino Roperto
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Carlo Giacobbo Scavo
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Ali Zomorodi
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Takanori Fukushima
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Luciano Mastronardi .

Editor information

Editors and Affiliations

  1. Unit of Neurosurgery ASLRoma1, San Filippo Neri Hospital, Roma, Italy

    Luciano Mastronardi  & Alberto Campione  & 

  2. Neurosurgery Department, Duke Medical Center, Raleigh, NC, USA

    Takanori Fukushima

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer Nature Switzerland AG

About this chapter

Cite this chapter

Mastronardi, L. et al. (2019). Retrosigmoid Approach. In: Mastronardi, L., Fukushima, T., Campione, A. (eds) Advances in Vestibular Schwannoma Microneurosurgery. Springer, Cham. https://doi.org/10.1007/978-3-030-03167-1_5

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-03167-1_5

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-03166-4

  • Online ISBN: 978-3-030-03167-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation