Surgical strategy and outcome evaluation of acoustic neuroma resection through suboccipital retrosigmoid approach

Objectives To investigate the surgical strategy and evaluate the surgical results of acoustic neuroma resection through suboccipital retrosigmoid approach. Methods A total of 319 cases of acoustic neuromas underwent surgical resection through suboccipital retrosigmoid approach at Neurosurgery Department, Changzheng Hospital, Naval Military Medical University from January 2007 to December 2017 and retrospectively reviewed and analyzed in this study. Electroneurophysiological monitoring was conducted during the whole course of operation. Postoperative facial nerve function was assessed based on House-Brackmann (H-B) scale. Results Among all 319 cases, 291 (91.2%) tumors were totally or subtotally resected and 28 (8.8%) were partially resected. 221 (69.3%) patients did not develop any postoperative complications and 39 (12.2%) had intracranial infections, 11 (3.5%) reported intracranial hematoma, 10 (3.1%) had choke on water, 10 (3.1%) had cerebrospinal fluid leakage, and 3 (0.9%) died. A total of 262 patients were followed up for 3-89 months (median: 42 months). At 3-6 months post operation, the assessment of facial nerve function indicated grade Ⅰ in 148 (56.5%) cases, grade Ⅱ in 72 (27.5%) cases, grade Ⅲ in 26 (9.9%) cases and grade Ⅳ in 16 (6.1%) cases. There were 5 (1.9%) cases of tumor recurrence and 1 death reported during follow-up. Conclusion Microsurgical resection through suboccipital retrosigmoid approach combined with electroneurophysiological monitoring appears to be safe and effective for the treatment of acoustic neuromas with a relative low recurrence rate. Key words: Neuroma, acoustic; Microsurgery; Facial nerve; Suboccipital postsigmoid approach; Neurophysiological monitoring