[Enlarged translabyrinthine resection of recurrent acoustic neuroma after suboccipital resection].

OBJECTIVE

To evaluate the technique and the outcome of enlarged translabyrinthine removal of recurrent acoustic neuromas after a suboccipital resection.

METHOD: Five patients were proved to have recurrent acoustic neuromas after previous suboccipital removal procedures. Revision surgery was accomplished in these patients using the enlarged translabyrinthine approach by sufficiently removing petrous temporal bone to enlarge exposed sight during the operation.

RESULT: The sizes of the recurrent tumors ranged from 2.5 to 4.0 cm. Total removal was achieved in all patients, with no death and other major complications such as intracranial infection and cerebrospinal fluid leakage. The facial nerve function was the same as pre-operative condition. There was no residual tumor showed in CT scans and MRI examinations after operation. The cerebel and brainstem resumed to normal position in each patient. No second recurrences had occurred to date at follow-up of 6 months to 2 years and 7 months. All patients recuperated and came back to work.

CONCLUSION

Acoustic neuroma recurs frequently after the suboccipital surgery because there is a residual tumor inside the internal acoustic canal (IAC). The enlarged translabyrinthine approach is the most direct access to acoustic neuroma and the brainstem by which recurrent tumor can be removed is avoided during the second operation. Moreover, it is praisable that there are several advantages such as slight invasion and convenience of facial nerve orientation so as to excellent outcome of facial nerve preservation in the enlarged translabyrinthine surgery.