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CC BY-NC-ND 4.0 · J Neurol Surg B Skull Base 2023; 84(03): 288-295
DOI: 10.1055/a-1793-7925
Original Article

The Combined TL-RS Approach: Advantages and Disadvantages of Working 360 Degrees around the Sigmoid Sinus

Maarten Kleijwegt 
1   Department of ENT, Leiden University Medical Center, RC Leiden, The Netherlands
,
Radboud Koot
2   Department of Neurosurgery, Leiden University Medical Center, RC Leiden, The Netherlands
,
Andel van der Mey
1   Department of ENT, Leiden University Medical Center, RC Leiden, The Netherlands
,
Erik Hensen
1   Department of ENT, Leiden University Medical Center, RC Leiden, The Netherlands
,
Martijn Malessy
2   Department of Neurosurgery, Leiden University Medical Center, RC Leiden, The Netherlands
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Abstract

Objective To highlight the advantages and disadvantages of the combined translabyrinthine (TL) and classic retrosigmoid (RS) approaches.

Design Retrospective chart review.

Setting National tertiary referral center for skull base pathology.

Participants Twenty-two patients with very large cerebellopontine angle tumors were resected using the combined TL-RS approach.

Main Outcome Measures Preoperative patient characteristics including age, sex, and hearing loss. Tumor characteristics, pathology, and size. Intraoperative outcome: tumor removal. Postoperative outcomes included facial nerve function, residual tumor growth, and neurological deficits.

Results Thirteen patients had schwannoma, eight had meningioma, and one had both. The mean age was 47 years, mean tumor size was 39 × 32 × 35 mm (anterior–posterior, medial–lateral, craniocaudal), and mean follow-up period was 80 months. Tumor control was achieved in 13 patients (59%), and 9 (41%) had residual tumor growth that required additional treatment. Seventeen patients (77%) had postoperative House–Brackmann (H-B) facial nerve function grades I to II, one had H-B grade III, one H-B grade V, and three H-B grade VI.

Conclusion Combining TL and RS approaches may be helpful in safely removing large meningiomas and schwannomas in selected cases. This valuable technique should be considered when sufficient exposure cannot be achieved with the TL or RS approach alone.

Keywords

cerebellopontine angle - petroclival - retrosigmoid - sigmoid sinus - translabyrinthine


Publication History

Received: 29 December 2021

Accepted: 06 March 2022

Accepted Manuscript online:
10 March 2022

Article published online:
06 June 2022

© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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