Intracanalicular Acoustic Neuroma
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Small intracanalicular acoustic neuromas may be removed with the hope of avoiding complete hearing loss. This is resection of such tumor via the retromastoid approach in the case of a 21-year-old male who presented with decreased hearing and vertigo, MRI evaluation revealed a small intracanalicular acoustic neuroma. To avoid further hearing loss in this young patient, resection of the mass was undertaken. Left sided retromastoid craniotomy was completed, sigmoid sinus was unroofed, and seven and eighth cranial nerves were exposed within this CP angle. I used a piece of rubber dam to slide around the cerebellum and avoid any injury to the surface of the cerebellum. Here is generous dissection of the arachnoid bands over this seven and eighth cranial nerves. You can see the seventh cranial nerve just anterior to the eighth. Obviously, this tumor is entirely intracanalicular, so I don't expect to see any tumor within the CP angle. The dural over the IC was stripped away and drilling a load 270 degree of skeletonization of the IC. Here's the tumor within the canal. The part of the vestibular nerve involved with the tumor is also isolated. Obviously, the cochlear nerve is carefully protected during the procedure. Sickle knife is used for sharp sectioning of their affected vestibular nerve and removal of the tumor. Here, you can see the tumor with the affected part of the vestibular nerve. Brainstem auditory evoked responses were monitored during the entire operation. Here's the stump of the vestibular nerve that led to the tumor. Piece of fat was used to gently cover the canal and the air cells and minimize the risk of postoperative CSF fistula, postoperative MRI demonstrated gross total removal of the mass. And this patient's hearing actually improved after the surgery. Thank you.
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