J Korean Neurosurg Soc.  2002 May;31(5):419-423.

Presigmoid Transpetrosal Approach for Recurrent Acoustic Neurinomas: Indications and Surgical Results

• Kang JH
• Hwang SK
• Gwak HS
• Kim DG
• Jung HW

Abstract

OBJECTIVE
In order to facilitate total removal with preservation of the facial nerve, the authors applied presigmoid(PS) approach in some patients with recurrent acoustic neurinoma(AN) patients who had undergone previous retrosigmoid(RS) approaches. The surgical outcomes of PS approach were retrospectively analyzed and compared to those of RS approaches and we suggest the indication of PS approach for recurrent AN.
METHODS
From 1989 to 1999, twenty-one of 183 operated AN patients underwent re-operation due to regrowth of the residual tumors. Nine of the 21 recurrent tumors were removed by PS approach and 12 cases underwent RS approach. The surgical extent of removal and the facial nerve preservation rate were compared between the two different approaches.
RESULTS
In PS approaches, the total removal was achieved in four patients(44%) and the facial nerve could be identified and preserved anatomically in all patients. Among 12 cases who underwent RS approaches, the rate of total removal was 44% and the facial nerve identified and preserved in only 5 cases (42%). The rate of facial nerve preservation was significantly different between two modes of approaches (p=0.0007).
CONCLUSION
PS transpetrosal approach is recommended in recurrent AN patients who had underwent RS approach previously and already lost the hearing. Early identification of the facial nerve and easy removal of the tumors can be achieved using the PS approach.

Keyword

Recurrence; Acoustic neurinoma; Retrosigmoid approach; Presigmoid approach; Facial nerve

MeSH Terms

Acoustics*
Facial Nerve
Hearing
Humans
Neoplasm, Residual
Neuroma, Acoustic*
Recurrence
Retrospective Studies