Initial Experience With the Retrosigmoid Inframeatal Approach in Skull Base Surgery

Introduction: Lesions of the petrous apex involving the inframeatal/infralabyrinthine region are challenging for surgical removal and have a high risk of approach related complications. Traditionally, various extensive skull-base approaches have been used for these lesions. The aim of this study was to present and evaluate our initial experience with a new hearing-preserving extension of the classic retrosigmoid approach to the inframeatal/infralabyrinthine area. Case Presentation: The approach was used in four patients harboring lesions in the petrous apex with variable extension in the inframeatal/infralabyrinthine region. The surgical accessibility of the lesions offered by the approach, completeness of tumor removal, the outcome, in particular, the functional outcome and complication rate, were assessed. Conclusions: The tumor could be gross totally resected in all the four cases. No approach-related morbidities occurred. Serviceable hearing and normal facial nerve functions were preserved in all cases. Our initial experience with the retrosigmoid inframeatal approach revealed that it provides sufficient access to the inframeatal/infralabyrinthine region and offers the possibility of complete tumor removal without any major complications. It allows for hearing and facial nerve functional preservation.