Initial Experience With the Retrosigmoid Inframeatal Approach in Skull Base Surgery

Abstract

Introduction:Lesions of the petrous apex involving the inframeatal/infralabyrinthine region are challenging for surgical removal and have a high risk of approach related complications. Traditionally, various extensive skull-base approaches have been used for these lesions. The aim of this study was to present and evaluate our initial experience with a new hearing-preserving extension of the classic retrosigmoid approach to the inframeatal/infralabyrinthine area. Case Presentation: The approach was used in four patients harboring lesions in the petrous apex with variable extension in the inframeatal/infralabyrinthine region. The surgical accessibility of the lesions offered by the approach, completeness of tumor removal, the outcome, in particular, the functional outcome and complication rate, were assessed. Conclusions: The tumor could be gross totally resected in all the four cases. No approach-related morbidities occurred. Serviceable hearing and normal facial nerve functions were preserved in all cases. Our initial experience with the retrosigmoid inframeatal approach revealed that it provides sufficient access to the inframeatal/infralabyrinthine region and offers the possibility of complete tumor removal without any major complications. It allows for hearing and facial nerve functional preservation.

Retrosigmoid Infralabyrinthine (Suprajugular) Approach to the Jugular Foramen: Indications, Limitations, and Surgical Nuances

“…We perform surgery in dorsal decubitus because the angle of attack is from cranial to caudal; however, other authors have used semisitting and parkbench positioning. 3,4,6,19 The head is elevated 30°and rotated to the contralateral side using a shoulder cushion, leaving the maxilla as the highest point of the field. Softtissue dissection does not differ from a standard retrosigmoid approach, and we recommend palpating the lateral mass of C1 without exposing it.…”