SURGICAL TREATMENT OF ACOUSTIC NEUROMASTHROUGH RETROSIGMOID APPROACH

Abstract

Background: Acoustic neuromas are rare, benign tumors arising from Schwann cells of vestibular portion of 8th cranial nerve. Frequent presenting symptoms are unilateral hearing loss, and subsequent tinnitus and vertigo.
Objectives: To enhance patient outcomes and quality of life by developing and optimizing safe, effective, and efficient surgical approaches for the treatment of acoustic neuromas.
Methods: The study was conducted at Mardan Medical Complex, Mardan, from January 2018 to January 2022, comprising 25 patients diagnosed with acoustic neuromas through CT scan and MRI. The tumor size was categorized based on its maximum diameter, with tumors less than 1.5 cm classified as small, tumors computing 1.5-3 cm classified as medium, and tumors > 3 cm classified as large, removed surgically through middle fossa, retrosigmoid and translabyrinth approach.
Results: We found that 56% of patients had small-sized tumors, 28% had medium and 16% had largesized tumors. They were surgically managed and preserved hearing in 33.33, 25 and 0% of small, medium and large-sized tumors, respectively. Facial nerve was preserved in 85.71, 71.42 and 50% of patients of the former categories, respectively. No complications were seen in patients with smallsized tumors, 14.28% in medium and 25% in large-sized.
Conclusion: Surgical treatment is one of the mainstays of management, and relies on various factors, and goal of surgery should be to minimize complications and maximize functional outcomes. For instance, translabyrinthine approach involves the removal of large-sized tumors, middle fossa for small and retrosigmoid for medium-sized neuromas.