Presigmoidal infra- and retrolabyrinthine access to the internal auditory canal for extirpation of vestibular schwannomas

The three standard access pathways (translabyrinth, transtemporal, and retrosigmoid) are traditionally used to extirpate vestibular suspensory schwannomas, depending on tumor size.

In three patients with T1 to T2 vestibular neuromas we chose the presigmoidal, retrograde, and infralabyrinthine access pathway for extirpation of the mass. The access path is similar to the translabyrinthine access route, whereby the semicircular canals are merely thinned out (blue lining) and not completely worn away. By discontinuation of the petrous sinus sup. the space is softened to the middle and posterior fossa and can be retracted if necessary. Due to the mastoidectomy, the anterior part of the access pathway is widened compared to the retrosigmoid access route, so that the retraction of the cerebellum is significantly lower. Due to the lower retraction of the cerebellum and the cerebrum, the recovery break is significantly reduced.

One patient had a high-grade sensorineural hearing loss preoperatively, and one patient was preoperatively deaf. Both were deaf postoperatively. One patient opted for CI care and was successfully rehabilitated. In a patient with preoperative residual hearing this could be obtained postoperatively. In one patient a delayed facial palsy grade II occurred postoperatively for 4 weeks, in one patient a temporary grade V facial palsy occurred on the 1st postoperative day. In both patients, facial nerve palsy was completely retrograde.

Overall, the presigmoidal, retro-infra-labyrinthine access pathway is a safe entryway for the removal of vestibular schwannomas in the hands of ENT surgeons with a comparatively gentle postoperative course for the patients.

Poster-PDF A-2025.PDF

Publication History

Article published online:
10 June 2020