Keyhole Retractorless Retrosigmoid Approach for CPA Meningiomas

Introduction: Recent evidence has pointed toward maximal resection as being the optimum strategy to prevent tumor recurrence in cerebellopontine angle (CPA) meningiomas. Nevertheless, durable tumor control through aggressive resection has been shown to occur at the expense of facial nerve function and to risk other approach-related complications. We aim to report and justify key techniques to maximize tumor resection and reduce surgical morbidity.

Methods: Between January 2022 and July 2023, from a prospectively collected database from a surgeon case-log, patients with cerebellopontine angle (CPA) meningiomas undergoing surgical resection were selected for statistical analysis. Only patients undergoing keyhole retractorless retrosigmoid approach were included. Patients with follow-up inferior than 3 months were excluded.

Results: Five patients between 41- and 84-year-old were included. Length overall stay was 1.5 days. GTR was achieved in 100% of patients. 1 patient had preop hearing loss that did not improved after treatment. 1 patient had mild facial palsy that improved after intervention. One patient had temporary facial palsy in the immediate preop (HB > 2), with complete recovery at 3 months. Rate of CSF leak, wound infection, meningitis or pseudomeningocele was 0%. 40% of patients experienced improvement in their QoL as soon as 6 weeks, and 80% at 3 months. No recurrence were observed in the period of observation (median 9 months, range 3 to 18 months).

Conclusion: This pilot study proves that surgical resection of CPA meningiomas through KH-RSa is doable and reasonable alternative for patients with CPA meningiomas, even in hands of more junior skull base neurosurgeons. Analysis of safety and long-term results demands larger number of patients to be included.

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Artikel online veröffentlicht:
05. Februar 2024