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OTORINOLARINGOLOGIA

A Journal on Otorhinolaryngology, Head and Neck Surgery,
Plastic Reconstructive Surgery, Otoneurosurgery


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Otorinolaringologia 1999 March;49(1):17-20

language: Italian

Acoustic neurinoma surgery. Indications for the translabyrinthine or retrosigmoid approach

Albera R., Morra B.*, Ferrero V., Cavalot A. L., Giordano L., Fadda G. L., Benech F.**

Università degli Studi - Torino II Clinica ORL - Dipartimento di Fisiopatologia Clinica Azienda Ospedaliera San Giovanni Battista - Torino
* Divisione ORL
** Dipartimento di Neuroscienze Sezione di Neurochirurgia


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Background. The principal approaches followed in acoustic neuroma (AN) surgery are the retrosigmoid (RS) and the translabyrinthine (TL). Aim of the study: to compare the results obtained following the two approaches and to discuss our present surgical strategy.
Methods. The study was conducted on 42 subjects affected by AN, 18 of them operated on by the TL approach and 24 by the RS approach. Mean AN extracanalicular maximum lenght was 2.7 cm.
Results. Among subjects treated by the RS approach 71% of cases presented a large AN, grade III-IV, while among subjects treated by the TL the rate of large AN drops to 39%. There were no differences between the two groups of patients, divided on the basis of the surgical approach followed, as regards age, lenght of operation and postoperative care or problems. Audiometric threshold was better in subjects treated by the RS approach and affected by small AN, while there were no diffences among the other groups. A postoperative permanent VII nerve deficit was evident in 33% of cases, almost exclusively in large AN.
Conclusions. On the basis of personal experience we prefer to remove large AN by RS approach since it offers a better view of the operative field, while in small AN, grade I-II, the approach is chosen on the basis of the residual hearing function; if hearing is still serviceable we prefer the RS approach while in case of profound hearing loss we follow the TL one.

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