Abstract at the 1988 meeting of the american academy of otolaryngologyhead and neck surgery in washington, dc, herbert silverstein, md, sarasota, fla. To present and evaluate our experience with a new hearing preserving extension of the. Methods we identified 346 and patients who underwent rs and tl approaches, respectively, for an resection in the 2010. We provide a modified surgical technique called retrosigmoidtranstentorial approach rtta to solve these. The classification of posterior petrous meningiomas and its clinical significance fj qu1, xd zhou1, xl wang2, f li 1, xd lu3, yg liu1, yh zhong4, ha yang1 and sl ni1 1department of neurosurgery, and 2department of the digestive system, qilu hospital, shandong university, jinan, china. Three hundred patients with idiopathic hemifacial spasm who underwent microvascular decompression through the retrosigmoid approach are reported. This video describes the classic retrosigmoid approach for the resection of petroclival lesions.
Surgical approaches for resection of vestibular schwannomas. The results of 1 to 6 years of followup show that 276 patients are free of the symptom, 4 patients have markedly diminished spasms and a decreased episode rate, 10 patients have no. Retrosigmoid intradural suprajugular approach to jugular. From december 1993 to december 2004, a total of 1,177 cases of endoscope assisted minimally invasive retrosigmoid approach were performed at the otorhinolaryngology unit of hopital nord in marseille. The retrosigmoid approach is a workhorse approach to the cerebellopontine angle cpa, providing access from the foremen magnum to the tentorium. Retrosigmoid versus translabyrinthine approach for acoustic.
We described the retrosigmoid suprajugular approach with its advantages, caveats, and indications. A new method of patients head positioning in suboccipital. Of these, the retrosigmoid lateral suboccipital approach lsa is the most convenient and frequently used. Several approaches to lesions in the cerebellopontine angle cpa have been employed 3, 10, 11, 14, 19, 21, 22, 25. The retrosigmoid or lateral suboccipital approach is the most commonly used approach and is also indicated for tumors of all sizes, particularly when hearing preservation is the goal. Transmastoid retrosigmoid approach to the cerebellopontine. By using this approach, we performed microvascular decompression for hemifacial spasm and trigeminal neuralgia, vestibular neurotomy for. May 16, 2016 this is a demonstration of the retrosigmoid approach for microsurgical resection of a cerebellopontine angle tumor. Decompressive craniectomy for the treatment of refractory high intracranial pressure in. Ultrasoundguided superficial cervical plexus block for. Retrosigmoid approach for acoustic tumor removal sciencedirect.
This approach may be a modification of retrosigmoid transmeatal approach to acoustic tumors. Download the pdf to view the article, as well as its associated figures and tables. As in the case with the pterional craniotomy for supratentorial parasellar lesions, the retromastoid craniotomy is the workhorse of infratentorial approaches for reaching the cerebellopontine cp angle and ventrolateral brainstem. Article information, pdf download for is the middle fossa approach the treatment of. Watertight dural suture is challenging, and different ways to reinforce it have been proposed. Cerebrospinal fluid csf leakages represent a major complication of skull base surgery. The retrolabyrinthine approach for division of the trigeminal nerve was described by hitselberger and pulec in 1972, 9 and in 1978, brackmann and hitselberger reported treatment of vertigo and tic douloureux by selective division of the vestibular and trigeminal nerves via a retrolabyrinthine approach. Retrosigmoid approach to vestibular nerve section jama. Video 11, 2014 retrosigmoid approach for resection of petroclival meningioma anil nanda, m. Retrosigmoid approach the neurosurgical atlas, by aaron. An endoscopic assisted retrosigmoid approach to the. It also provides the demographics, presenting features and the. The primary objective of the study was to assess hearing and facial nerve status before and after the surgery via the retrosigmoid approach. Jun 18, 2016 petroclival meningiomas pcms are technically challenging lesions.
An endoscopic assisted retrosigmoid approach to the cerebellopontine angle for resection of an epidermoid cyst mina g. Eventually, small oblique incisions are accomplished to increase surgical exposure 3, 2 and 4 tackup dural sutures for enhancement of the surgical view courtesy of prof. A stepwise illustration of the retrosigmoid approach for. Read retrosigmoid approach, operative techniques in otolaryngologyhead and neck surgery on deepdyve, the largest online rental service for scholarly research with thousands of academic publications available at your fingertips. Cerebellopontine angle and retrosigmoid approach cerebellopontine angle. The horizontal fissure arrows is easily identified on the petrosal surface.
Indications for this approach are variable such as resection of meningiomas, acoustic neuromas and epidermoid tumors, treatment of vascular lesions of. Retrosigmoid approach to tumors of the cerebellopontine angle. The cerebellopontine angle cpa is the seat of different pathologies. The retrosigmoid suprajugular approach provides an excellent option for tumors with a. The retrosigmoid suprajugular approach provides a lessaggressive approach for a subset of tumors of the jugular foramen. Retromastoid craniotomy the neurosurgical atlas, by. Clinical features and outcomes in patients with non. Retrosigmoid approach to the posterior and middle fossa. Retrosigmoid approach, acoustic neuromas, vestibular neurectomy. Retrolabyrinthine retrosigmoid vestibular neurectomy.
The space created after drilling the suprameatal tubercle and the bone medial to the internal auditory canal and below the trigeminal nerve was enough to extend the retrosigmoid approach as far as. Sep 28, 2018 the retrosigmoid approach also can be extended superiorly and combined with the intradural suprameatal approach. Comparison of facial nerve function results after translabyrinthine and retrosigmoid approach in mediumsized tumors. These features were studied in patients presenting to the regional neurootological unit. Retrosigmoid suprafloccular transhorizontal fissure. We provide a modified surgical technique called retrosigmoid transtentorial approach rtta to solve these problems. The cerebellopontine angle is located between the superior and inferior limbs of the cerebellopontine fissure, an angular cleft formed by the petrosal cerebellar surface folding around the pons and middle cerebellar peduncle. Abstract full text pdf the retrosigmoid approach is a workhorse approach to the cerebellopontine angle cpa, providing access from the foremen magnum. This article describes the progressive widening of the posterior trajectory that begins with progressive drilling of the petrous bone the retrosigmoid approach. An assessment of complications and payments in a longitudinal. Abstract at the september 1986 meeting of the american academy of otolaryngologyhead and neck surgery in san antonio, tex, dr herbert silverstein, sarasota, fla, presented his results in 91 vestibular neurectomies for relief of vertigo. An endoscopic assisted retrosigmoid approach to the cerebello. Primary dural closure for retrosigmoid approaches garrett t. Suboccipital retrosigmoid approach for resection of.
This combined pre and retrosigmoid approach was performed on eight cadaveric heads 16 sides. Includes details on clinical presentation, evaluation, and indications of surgery. After first description by fedor krause in 1903, the unilateral approach to the cerebellopontine angle cpa have been developed and modified further by many surgeons. Download fulltext pdf download fulltext pdf retrosigmoid versus translabyrinthine approach for acoustic neuroma resection.
A new method of patients head positioning in suboccipital retrosigmoid approach ersin erdogan 1, erdinc civelek 1, mehmet bulent onal 1, ilker solmaz 1, cahit kural 1, hakan yakupoglu 2 1 department of neurosurgery, gulhane military medical academy, 06100 etlik, turkey 2 medicana ankara hospital 06200, cankaya ankara, turkey. A minimally invasive endoscope assisted retrosigmoid. Based on the definition of the extended pterional approach, lateral sphenoid wing is resected to the level of the. The traditional suboccipital craniotomy in the retrosigmoid approach gives limited exposure to the cerebellopontine angle cpa structures and necessitates cerebellar retraction, whereas the addition of drilling of the mastoid process with. The retrosigmoid suprajugular approach provides an excellent option for. Pdf retrosigmoid versus translabyrinthine approach for. Initial experience with the retrosigmoid inframeatal. This approach may be used for acoustic neuromas of all sizes, from intracanalicular, to more than 4 cm from the porus acusticus. A samiib2 glossopharyngeal nerve schwannoma is shown to exemplify the procedure. N2 the retrosigmoid approach is an ideal approach for lateral posterior fossa pathology.
Petroclival meningiomas pcms are technically challenging lesions. Endoscopeassisted retrosigmoid approach in hemifacial spasm. The keyhole retrosigmoid approach to the cerebellopontine. Initial experience with the retrosigmoid inframeatal approach. Th patient presented with gait disturbance and normal hearing. Object retrosigmoid rs and translabyrinthine tl surgery remain essential treatment approaches for symptomatic or enlarging acoustic neuromas ans. Is the middle fossa approach the treatment of choice for. Difference in dimension of a craniotomy performed with a traditional retrosigmoid approach and with the eamirsa. A stepwise illustration of the retrosigmoid approach for resection of a. To access the meckels cave, the approach should be combined with retrosigmoid intradural suprameatal approach. A minimally invasive endoscope assisted retrosigmoid approach.
The internal auditory canal can be accessed through different surgical approaches based on different trajectories. Cureus preservation of hearing and facial nerve function. Retrosigmoid approach to tumors of the cerebellopontine. Retrosigmoidtranstentorial approach for petroclival. The surgical approaches include retrosigmoid, middle fossa, translabyrinthine, and transpetrous approaches or their combinations. The primary objective of the study was to assess hearing and facial nerve status before. Schematic view of retrosigmoid approach showing the cshaped dural flap 1 and the tackup sutures 5. Surgical approaches for resection of acoustic neuromas. The unilateral suboccipital approach was popularized by woolsey and with great contributions by fedor krause after several refinements and modifications through different dedicated neurosurgeons fish, house and seiffert, dandys suboccipital approach with an ipsilateral suboccipital flap evolved to the retrosigmoid transmeatal approach. This approach provides direct access to the lateral cerebellar hemisphere, cerebellopontine. One of the advantages of retrosigmoid approach is that it provides a good exposure to the cranial nerve, brainstem.
Machine learning approach for prediction of hearing. A, picture and, b, illustration after dorsal retraction of the petrosal cerebellar surface of a cadaveric specimen. Vascular lesions and other pathology at this area can be exposed adequately by doing the classical retrosigmoid approach or its modifications. This approach may be utilized to manage tumors of the lateral posterior fossa and to perform microvascular. Cadaveric specimens demonstrating an operative view of the right retrosigmoid suprafloccular transhorizontal fissure approach. Although the postoperative facial nerve function results were better in the group of patients whose mediumsized tumors were removed through the tl approach compared with patients operated through the rs approach, the difference between these 2 groups was not statistically significant enough to favor one approach over the other. Suprajugular extension of the retrosigmoid approach. The retrosigmoid approach is a hearingpreserving operation that is used for tumors with mainly extracanalicular extension into the cpa and minimal extension into the iac. A 30degree endoscope was used to assist in removal of unseen tumor in meckels cave, medial to the lower cranial nerves, and along the ventral pons. Retrosigmoid approach augusta university research profiles. Microvascular decompression by the retrosigmoid approach. While performing this approach, there is no clear anatomical landmark of the horizontal segment of the petrous internal carotid artery.
The retrosigmoid approach offers a panoramic view of the cpa. The retrosigmoid approach offers an excellent exposure of the brainstem and cranial nerves iv through xii. This study presents a suprajugular extension of the retrosigmoid approach directed through the osseous roof of the jugular foramen that allows the removal of tumors located in the cerebellopontine angle with extension into the upper part of the foramen, with demonstration of an illustrative case. Abstract full text pdf surgical removal remains one of the key treatment modalities for vestibular schwannomas. Retrosigmoid approach definition of retrosigmoid approach. Cerebellopontine angle and posterior fossa cranial nerves by.
To evaluate the safety and efficacy of removing large acoustic neurinomas. Multiple approaches have been developed to permit the surgeon to tailor the procedure to a particular patients pathology and physiological status. The extended retrosigmoid approach for neoplastic lesions in the posterior fossa. Using microsurgical technique, the tumor was dissected away from the glossopharyngeal nerve. The keyhole retrosigmoid approach to the cerebellopontine angle. Department of neurosurgery, tufts medical center and tufts university school of medicine, boston, massachusetts epidermoid cysts are rare lesions accounting for 1%. We analyze surgical exposure and maneuverability of this approach and compare it with the surgical microscopic and a conventional singleport endoscopeassisted retrosigmoid approach. We retrospectively analyzed our experience with retrosigmoid approach between 2009 and 2015 in. This approach enables the surgery to be performed under visual control, due to wide. Of these, the retrosigmoid lateral suboccipital approach. The anatomic exposure of the posterior fossa provided by the retrosigmoid approach is bounded superiorly by the tentorium cerebelli and inferiorly by the jugular foramen and foramen magnum. Objectives nonacoustic tumours of the cerebellopontine angle differ from vestibular schwannomas in their prevalence, clinical features, operative management, and surgical outcome. Retrolabyrinthine and retrosigmoid vestibular neurectomy.
Retrosigmoid approach for resection of petroclival meningioma. Endoscopic skull base surgery chap 9, the fully endoscopic retrosigmoid approach by hrayr k. One year after tumor removal via retrosigmoid approach, 10 59% of the 17 patients had good grade iii facial functions and 2 12% had poor grade vvi. Abstract full text pdf the retrosigmoid approach is a workhorse approach to the cerebellopontine angle cpa, providing access from the foremen magnum to the tentorium. Removal of large acoustic neurinomas vestibular schwannomas. Review of an 11year experience in retrosigmoid approach. A suboccipital craniotomy was used for access to the cerebellopontine angle. Lateral suboccipital approach retrosigmoid springerlink.
Vascular compression was found in every patient on operation. Retrosigmoid versus translabyrinthine approach for. We present a 35yearold woman with left sided tongue numbness and lower lip paresthesias with a cpa epidermoid. It is the approach of choice for most tumors of the cp angle. Surgical technique for trigeminal microvascular decompression. These include the transmastoidtranslabyrinthine approach, the transtemporal extradural approach, and the lateral suboccipital retrosigmoid approach.
Retrosigmoid approach for vestibular schwannoma surgery. The main indication for the retrosigmoid approach remains the patient with. Review of an 11year experience in retrosigmoid approach for. Transmastoid retrosigmoid approach to the cerebellopontine angle.
In this videoabstract, we present a one burrhole craniotomy for the upper retrosigmoid approach developed in helsinki neurosurgery to access the lateral cerebellar hemisphere, the cerebellopontine angle, and lateral skull base e. Although the standard retrosigmoid approach is one of the most effective approaches, this route may have some limitations for the tumors extending into the supratentorial region and middle cranial fossa. The retrosigmoid approach is indicated for access to lesions of the lateral posterior fossa and lateral skull base from the level of the tentorium to the level of the foramen magnum. Madison michael, ii2,3 1college of medicine, universityof tennesseehealthsciencecenter, memphis, tennessee, united states. An endoscopic assisted retrosigmoid approach was utilized for resection. Retrosigmoid approach for resection of petroclival. After careful exploration of the trigeminal root entry zone, the offending vessel is identified and moved away. Excision began with the large extrameatal portion of the. Infratentorial approach is the approach performed beneath the tentorium of the cerebellum where as the retrosigmoid approach is suboccipital approach involving removal of a portion of the bone behind the ear.
Since 6 months, we use locally harvested autologous pericranium graft. The classification of posterior petrous meningiomas and. Oxidized regenerated cellulose is used to keep the vessel in its new position far from the nerve. This is a demonstration of the retrosigmoid approach for microsurgical resection of a cerebellopontine angle tumor. Indications for the retrosigmoid approach are summarized in table 5. Surgical removal remains one of the key treatment modalities for vestibular schwannomas.
This approach alone cannot provide access to the middle fossa dura or the meckels cave. The middle cranial fossa approach was found to be superior to the retrosigmoid approach for hearing preservation in patients with tumors approach, 1,2 the retrosigmoid approach is the most common microsurgical resection method used. Methods a retrospective analysis of clinical notes identified 42 patients with nonacoustic tumours of the. This approach provides direct access to the lateral cerebellar hemisphere, cerebellopontine angle, and lateral skull base, including the posterior petrous bone. The retrosigmoid approach is an ideal approach for lateral posterior fossa pathology. Madison michael, ii2,3 1college of medicine, universityof tennesseehealthsciencecenter, memphis, tennessee, united states 2department of neurosurgery, university of tennessee health science center, memphis, tennessee, united states. Infratentiorial approach verse a retrosigmoid approach. We compared nationwide complication rates and payments, independent of tumor characteristics, for these two strategies. Position the retrosigmoid approach can be performed with the patient in the sitting, parkbench, lateral or supine position with the head rotated maximally to the contralateral side.
Technical pearls for performance of a retrosigmoid approach for vestibular schwannoma. This is the randomised controlled trial to observe the efficacy and safety of preoperative ultrasoundguided superficial cervical plexus block on postoperative analgesia in patients undergoing craniotomy via suboccipital retrosigmoid approach. A team approach between a neurotologist and a neurosurgeon offers the patient the expertise of both specialties and maximizes the chances for an optimal outcome. Comparison of facial nerve function results after translabyrinthine and retrosigmoid approach in mediumsized. Though both the approaches are different, they can be used for excision of tumor cerebellopontine angle tumor. Retrosigmoid approach to vestibular schwannomas sciencedirect. Illustrations of skull base surgery and neurotology. Extensions of the retrosigmoid approach using intradural osseous drilling include the transmeatal and suprameatal approaches. Treatment options range from watchful waiting with serial imaging studies to radiosurgery or a microsurgical excision or a combination of surgery and radiation therapy. Aug 06, 2016 the retrosigmoid approach offers a panoramic view of the cpa. The retrosigmoid suprameatal approach was presented clinically by chanda and nanda for cerebellopontine angle tumors with invasion into meckels cave.
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