Transotic approach to the cerebellopontine angle

Area of Science:

• Neurosurgery
• Otolaryngology
• Skull Base Surgery

Background:

• Cerebellopontine angle tumors often invade the internal auditory canal.
• Preserving facial nerve function is a critical surgical challenge.
• Minimizing cerebrospinal fluid (CSF) leaks is essential for postoperative recovery.

Purpose of the Study:

• To evaluate the efficacy of the transotic approach for cerebellopontine angle tumor resection.
• To assess the impact of this approach on facial nerve preservation.
• To determine the effectiveness in preventing CSF leaks.

Main Methods:

• The transotic approach was utilized for tumor resection.
• Anterior exposure facilitated visualization of the intracranial facial nerve.
• Subtotal petrosectomy with middle ear cleft obliteration and musculofascial patching was performed.
• Facial nerve grafting or hypoglossal-facial anastomosis were considered when necessary.

Main Results:

• Superior illumination and exposure were achieved.
• Enhanced separation of the facial nerve from the tumor was observed.
• The approach is indicated for tumors up to 2.5 cm not adherent to the brain stem.
• Complications like CSF leaks were generally avoided.

Conclusions:

• The transotic approach provides excellent exposure for internal auditory canal tumors.
• It facilitates optimal facial nerve preservation and functional outcomes.
• This technique effectively reduces the risk of CSF leaks in selected tumor cases.