Acoustic Neuroma: Medium Size

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Here is another demonstration of techniques for a section of a medium size acoustic neuroma via the retromastoid approach. This is a 33 year old female with a fast growing neuroma, very unusual case. MRI evaluation reveals the morphology of the tumor with its intracanalicular extension. She underwent a left sided retromastoid craniotomy. Sigmoid sinus. Small transverse cut was made just short of the sinus to mobilize the dura. Here is the tumor. Tumor was debulked and mobilized away from the lower cranial nerves. It will also dissect the way for the trigeminal nerve. After the facial nerve near the brain stem was recognized, the intracanalicular portion of the tumor was removed. The vestibular nerve was disconnected and the tumor was removed to the level of the porus. Here's the facial nerve, tumor very adherent. Here's the level of the porus. Tumor is being removed piecemeal. Can see the nerve is intact. The tumor is being removed in very tiny pieces at the level of the porus. The arachnoid bands are gently disconnected. Here is the nerve. Very tiny piece of the tumor had to be left behind to protect anatomical continuity of the nerve. Post operative MRI demonstrated gross total removal of the mass. Obviously very small piece of tumor has been left behind. Five year followup imaging did not reveal any growth of the small residual tumor. Thank you.

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