Suboccipital Approach for Removal of Small Acoustic Neuromas

Abstract

Ten patients with confirmed acoustic neuroma were operated on with a suboccipital approach. The tumors were less than 20mm in diameter, and two of them were intracanalicular acoustic neuromas.
Until now, this approach was used mainly by neurosurgeons for relatively large tumors, but we took the suboccipital approach for small neuromas, because this approach provides a wide view.
The surgical team consists of a neurosurgeon, neurotologist, anesthesiologist and nursing personnel. The neurosurgeon makes the incision, performs the craniotomy, and exposes the tumor or the posterior aspect of the petrous bone as well as the VIIth and VIIIth cranial nerves in the cerebellopontine angle. The neurosurgeon debulks it and partially dissects it from the brain stem. Then, the neurotologist opens the internal auditory canal and removes the remainder of the tumor.
Five of the 10 patients had serviceable hearing, and pre-operative hearing levels were preserved in 3 of the 5. Functional preservation of the facial nerve was possible in 8. There were no serious postoperative complications.
Excision of a small neuroma shortly after diagnosis may offer the best chance of hearing preservation. The suboccipital approach may be advisable for the preservation of hearing and facial nerve function even if the neuroma is small.