Surgical Approaches to Cerebellopontine Angle: A 17-Year Experience of Our Skull Base Team

Abstract

Objectives:

We give an overview of the current state of cerebellopontine angle (CPA) surgery, based on the recent evidence, and describe our center’s experience in surgical approaches to these lesions.

Methods:

Retrospective review of cases who underwent surgery for CPA lesions at our hospital during the past 17 years (1996-2013), with focus on the description of the currently most used technique-extended retrosigmoid. We also conducted a brief review of the literature on CPA surgery, comparing the different approaches, their indications and complications.

Results:

During this period, 203 patients underwent surgery for CPA. The most frequent indication was vestibular schwannoma (84.7%). Other indications were meningiomas (8.4%), epidermoids (1%), vestibular neurectomies (1.5%), arteriovenous malformations (1%), anterior inferior cerebellar artery–posterior inferior cerebellar artery aneurysms (1%), trigeminal microscopic decompression (0.5%), and other more rare tumors (2%). The most used approach was extended retrosigmoid (71.9%), followed by the translabyrinthine (26.1%) and middle fossa approach (2%). Until 2004, the most used approach was the translabyrinthine; after 2004, the most used was the extended retrosigmoid.

Conclusions:

Currently, the preferred surgical approach used by our team is the extended retrosigmoid, because it allows a complete exposition of sigmoid sinus from the transverse sinus to the jugular bulb, enhances CPA vision, avoids cerebellar retraction, and is a simple way to get a wide route to the CPA. It also allows good functional outcomes (hearing and facial nerve preservation) in most cases. However, indications for approaches depend on the size of the lesion, its location and the quality of preoperative hearing, as well as a necessary familiarity with all approaches.