Surgery for Acoustic Neurinoma

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Abstract
This presentation is concerned with the one-stage translabyrinthine operation of small acoustic neurinomas and a combined translabyrinthine suboccipital staged operation for removal of large acoustic neurinomas. The technique for the translabyrinthine approach to the cerebellopontine angle is described in detail and demonstrated by photographs of the dissection as it progresses. The technique includes both a one-staged translabyrinthine operation for removal of small acoustic neurinomas and preparation of the involved field when the second stage suboccipital operation is necessary. The first 75 consecutive cases are reviewed. Total removal of tumor was accomplished in 43 of these patients by the translabyrinthine route with incidence of 12% permanent facial nerve paralysis. Twenty-seven patients required a second stage suboccipital operation. Total removal was accomplished in 16 of these patients. Only three of the 11 patients with subtotal removal of tumor have required additional surgery. There was an incidence of permanent facial nerve paralysis in eight of these patients. Five of 75 patients underwent a translabyrinthine operation with subtotal removal of tumor. A second stage suboccipital operation was not performed in these patients because of advanced age or refusal. One of these five patients has a permanent facial paralysis and none have required further surgery to date. There was an incidence of 18% permanent facial paralysis among the entire 75 cases. The author prefers the hypoglossal facial nerve anastomosis procedure for rehabilitation for those patients with facial nerve paralysis. There has been no operative mortality in this entire series and 94% of the patients have been able to resume their previous level of work and activity. There was only one transient episode of cerebrospinal fluid otorhinorrhea among the 75 patients.

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