Retrosigmoid approach in the removal of vestibular schwannoma

Background and Objectives: The use of several approaches, involving different cerebello-pontine angles, has enabled vestibular schwannoma removal to be tailored to each patient's pathology and physiological status. The retrosigmoid approach provides simple and direct access to cerebello-pontine angle lesions. Subjects and Methods: We retrospectively assessed outcomes in 35 consecutive patients who underwent vestibular schwannoma removal via the retrosigmoid approach. Results: Of the 35 patients, 12 were men and 23 women; their age was 52.5±10.4 years (range, 35-75 years). One tumor was small (≤1 cm), 18 were medium (1-3 cm), and 16 (45.7%) were large (>3 cm). Symptoms included hearing disturbance (31 patients, 89%), tinnitus (14 patients, 40%), headache (12 patients, 34%), vertigo (11 patients, 31%), and facial palsy (9 patients, 25%). Postoperative complications included facial palsy, intracranial hemorrhage, dysphagia, and disseminated intravascular coagulopathy, with facial palsy remaining permanently. Four patients (11.4%) had tumor regrowth, at a mean of 36.3 months after primary surgery. The mean diameter of regrowing tumors was 20.5±4.4 mm (range 14.5-25.0 mm). Conclusions: The retrosigmoid approach for vestibular schwannoma removal was associated with higher rates of facial palsy and hearing loss. This approach, however, can minimize injury to the lower cranial nerve.