The widened retrolabyrinthe approach: a new concept in acoustic neuroma surgery

For many years, the retrolabyrinthine approach has been limited to functional surgery of the cerebellopontine angle (CPA). As a result of the increased surgical exposure, particularly the opening of the internal auditory meatus (IAM), the widened retrolabyrinthine technique permits tumor excision from both the CPA and the IAM, regardless of the histological nature of the tumor. The authors have treated 60 acoustic neuromas of varying sizes via this approach (6% intrameatal tumors; 30% > 25 mm in diameter). The postoperative mortality rate was 0%. The risk of fistula formation was 3.3%, and 3.3% of the patients suffered from postoperative meningitis. The results for facial nerve function were equivalent to those obtained previously via a widened translabyrinthine approach and those in a series treated via a suboccipital approach (80% with Grades I and II, 15% with Grade III, and 5% with Grades V and VI). One patient (1.7%) required a secondary hypoglossal-facial nerve anastomosis and had attained a Grade IV result 6 months later. Postoperatively 21.7% of these patients maintained socially useful hearing and 20% had mediocre hearing. Socially useful hearing was preserved in 50% of a subgroup of 20 patients who had both good preoperative hearing and a tumor that involved less than half of the IAM regardless of its volume. Additionally, 15% had mediocre hearing that could be improved with hearing aids. Because of its efficacy in preserving hearing, the authors favor the retrolabyrinthine over the occipital approach, with the latter being considered less subtle and more aggressive.