Surgical Approaches for Resection of Acoustic

Surgical Approaches for Resection of Acoustic Neuromas A neuromas are the most common tumors of the cerebellopontine angle. Most are benign lesions that grow from the transition point between the central and peripheral myelin. They cause a wide variety of symptoms such as hearing loss, tinnitus, and balance abnormalities. Large lesions compress the contents of the posterior fossa and may cause cranial nerve dysfunction, long tract compromise, and even hydrocephalus if they grow large enough to obstruct cerebrospinal fluid (CSF) pathways. The internal auditory canal (IAC) can be accessed from different angles, and decisions about the right approach are based on clinical and radiological information. A “team approach” is standard for patients with cerebellopontine angle tumors, especially acoustic neuromas. The team is composed of otolaryngological surgeons specializing in temporal bone anatomy and neurotology and of neurosurgeons dedicated to microneurosurgery. A team approach offers patients the expertise of both disciplines. The neurotologist performs the surgical exposure, which frequently involves progressive drilling of the petrous bone, and the neurosurgeon removes the tumor. The microanatomy of these approaches, which is beyond the scope of this review, is illustrated elsewhere. This article discusses the advantages and indications of each approach, relevant surgical anatomy, and surgical nuances.