Surgery for Vestibular Schwannomas and Other Cerebellopontine Angle Tumors

Abstract

  Vestibular schwannoma surgery is one of the most challenging fields, and achieving both maximal tumor removal and preservation of facial and/or hearing functions is difficult. Therefore, intraoperative monitoring, surgical technique based on the microsurgical anatomy and sufficient experience in this field are mandatory to obtain excellent surgical results. The author considers that the key points of removing large vestibular schwannomas (VS) are continuous facial nerve monitoring, deep and wide opening of the internal auditory canal, 7 gates for removing a tumor, 3 planes in tumor dissection, V-cut technique, and lifting up the tumor from the cerebellopontine (CP) angle cistern, from his personal surgical experience of 1,490 CP angle tumors including 1,074 VS. In this article, surgical points for trigeminal and jugular foramen schwannomas, CP angle and skull base meningiomas, and CP angle epidermoid cysts are also described.