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The retrolabyrinthine approach.

Per Cayé-Thomasen1

  • 1Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.

Handbook of Clinical Neurology
|October 6, 2025
PubMed
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The retrolabyrinthine/presigmoid approach offers a minimally invasive option for cerebellopontine angle tumors, potentially preserving hearing and vestibular function. Advanced neuromonitoring and endoscopy enhance surgical outcomes and safety.

Area of Science:

  • Neurosurgery
  • Skull Base Surgery

Background:

  • The cerebellopontine angle (CPA) is a critical surgical area housing important cranial nerves and vasculature.
  • Traditional surgical approaches to the CPA may carry risks to neurological function.

Purpose of the Study:

  • To describe the development, technique, results, and complications of the retrolabyrinthine/presigmoid approach to the CPA.
  • To highlight the benefits of this approach in managing CPA pathologies and performing specific neurosurgical procedures.

Main Methods:

  • Detailed description of the retrolabyrinthine/presigmoid surgical technique.
  • Integration of contemporary neuromonitoring for real-time functional assessment (hearing, facial nerve).
  • Utilization of endoscopic assistance for enhanced visualization and surgical precision.
Keywords:
Brainstem implantCerebellopontine angleEndoscopesHearing preservationVestibular schwannoma

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Main Results:

  • The approach is applicable to a wide range of CPA pathologies, including tumors and for procedures like vestibular neurectomy.
  • Potential for preservation of hearing and vestibular function.
  • Improved surgical outcomes and preservation of crucial anatomic structures through advanced technology.

Conclusions:

  • The retrolabyrinthine/presigmoid approach is a valuable, albeit overlooked, surgical option for the cerebellopontine angle.
  • The combination of this approach with neuromonitoring and endoscopy optimizes patient outcomes and minimizes complications.