Recurrent acoustic tumor after a suboccipital removal

Surgery for acoustic tumors has several priorities. First and foremost is the preservation of life with the total removal of the tumor; second is the preservation of the facial nerve; and last, when applicable, is the preservation of hearing. During the suboccipital (retrosigmoid) removal of a tumor, the surgeon unknowingly may leave tumor remnants leading to regrowth. We present five cases of recurrent acoustic tumors after a suboccipital removal. Inadequate drilling exposure of the internal auditory canal was the probable direct cause for tumor recurrence. A translabyrinthine removal is the best approach for total exposure of the entire internal auditory canal. The consequences of small tumor remnants will be discussed as well as their clinical relevance. Current radiological imaging and surgical techniques that avoid residual tumor will be presented.