Microsurgical Resection of Intracanalicular Vestibular Schwannoma via Retrosigmoid Approach: 3-Dimensional Operative Video

Vestibular schwannomas are a multifaceted group of tumors that can present with different sizes and involvement of critical neurovascular structures.(1-6) While operating on these tumors, a critical goal is postoperative preservation of facial nerve function and hearing. We present the case of a 66-year-old male with a history of severe left-sided tinnitus and progressive hearing loss (Video 1). Preoperative imaging depicted a lesion highly suggestive of an intracanalicular vestibular schwannoma. Due to worsening of symptoms and after thoughtful discussion with the patient, microsurgical resection was indicated under constant neurophysiologic monitoring. A retrosigmoid approach was employed, and the posterior wall of the internal auditory canal was opened, allowing exposure of tumor and its total resection. Postoperative imaging demonstrated complete tumor resection. The patient's symptoms improve, and there were no new neurologic deficits on follow-up. Anatomical images were a Courtesy of the Rhoton Collection, American Association of Neurological Surgeons (AANS)/Neurosurgical Research and Education Foundation (NREF).

Automated summary

Vestibular schwannomas are a diverse group of tumors that require careful surgical planning to preserve facial nerve function and hearing postoperatively. Microsurgical resection was successful in achieving complete tumor removal, resulting in improved symptoms and absence of new neurologic deficits in follow-up.