Acoustic Neuroma Surgery: Retrosigmoid Techniques

Abstract

The last century has seen great strides in the accurate diagnosis and microsurgical management of acoustic neuroma (AN), with improvements in mortality rate and preservation of both facial nerve function and hearing [1]. Acoustic neuromas were among the earliest intracranial lesions to be anatomically localized on the basis of symptoms [2, 3]. The first reported surgical attempt was by Charles McBurney, who opened the suboccipital plate with a chisel in 1881 but was forced to abort the case following excessive cerebella swelling [4]. Early surgical attempts were heroic interventions of last resort in moribund patients and were associated with surgical mortality rates of up to 78% [5]. With developments in surgical technique and sterility, Harvey Cushing reported a mortality rate of 4% in 1931 [6]. Walter Dandy further advanced the field using ventriculographic and pneumoencephalographic imaging and a unilateral suboccipital craniotomy [7, 8]. With such advancements, complete tumor excision became more commonplace and rates of anatomic preservation of the facial nerve approached 65% in 1941 [9–11].